Coordinates	0°23′24″N9°27′0″N
{{infobox disease | name	Strabismus | Image Strabismus.jpg | Caption Strabismus prevents bringing the gaze of both eyes to the same point in space. | DiseasesDB 29577 | ICD10 – | ICD9 | ICDO | OMIM 185100 | MedlinePlus 001004 | eMedicineSubj | eMedicineTopic | MeshID D013285 }}

Strabismus (; Modern Latin, from Greek στραβισμός ''strabismos''; cf. στραβίζειν ''strabizein'' "to squint", στραβός ''strabos'' "squinting, squint-eyed") is a condition in which the eyes are not properly aligned with each other. It typically involves a lack of coordination between the extraocular muscles, which prevents bringing the gaze of each eye to the same point in space and preventing proper binocular vision, which may adversely affect depth perception.

Strabismus can be either a disorder of the brain in coordinating the eyes or of one or more of the relevant muscles' power or direction of motion. Difficult strabismus problems are usually co-managed between orthoptists and ophthalmologists.

Classification

Paralytic strabismus

Forms of paralytic strabismus include

Third (oculomotor) nerve palsy

Fourth (trochlear) nerve palsy

* Congenital fourth nerve palsy

Sixth (abducent) nerve palsy

Total (external) ophthalmoplegia

Progressive external ophthalmoplegia

Other

* Kearns-Sayre syndrome

Other strabismus

Other forms of strabismus include:

Convergent concomitant/Divergent concomitant

* Esotropia

* Exotropia

Vertical strabismus

* Hypertropia

* Hypotropia

Other and unspecified heterotropia

* Microtropia

* Monofixation syndrome

Heterophoria

* Esophoria

* Exophoria

Mechanical strabismus

* Brown's sheath syndrome

Other

* Duane syndrome

Signs and symptoms

One eye moves normally, while the other points in (esotropia or "crossed eyes"), out (exotropia), up (hypertropia) or down (hypotropia).

Strabismus is often mistakenly referred to as "lazy eye" or known as amblyopia; a result from constant unilateral strabismus. It also be referred to as "crossed eyes", “wandering eyes”, or having a “cast”. Other names include "squint", "crossed eye", "spaggy eye", "google eye", "boss eye", "cock eye", "wonk eye", "codeye", "wok eye", "gam gam", "gloucester-ledbury","Ryland Optic Disorder", "sockeye" and "wall eye".

"Cross-eyed" means that when a person with strabismus looks at an object, one eye fixes on the object and the other fixes with a convergence angle less than zero; the optic axes overconverge. "Wall-eyed" means that when a person with strabismus looks at an object, one eye fixes on the object and the other fixes with a convergence angle greater than zero; that is, the optic axes diverge from parallel.

Pathophysiology

Strabismus can be caused when the cranial nerves III (oculomotor), IV (trochlear) or VI (abducens) have a lesion. A strabismus caused by a lesion in either of these nerves results in the lack of innervation to eye muscles and results in a change of eye position. A strabismus may be a sign of increased intracranial pressure, as CN VI is particularly vulnerable to damage from brain swelling, as it runs between the clivus and brain stem.

More commonly however, squints are termed concominant (i.e. non paralytic). This means the squint is not caused by a lesion reducing innervation. The squint in this example is caused by a refractive error in one or both eyes. This refractive error causes poor vision in one eye and so stops the brain from being able to use both eyes together.

Diagnosis

During eye examinations, orthoptists, ophthalmologists and optometrists typically use a cover test to aid in the diagnosis of strabismus. If the eye being tested is the strabismic eye, then it will fixate on the object after the "straight" eye is covered, as long as the vision in this eye is good enough. If the "straight" eye is being tested, there will be no change in fixation, as it is already fixated. Depending on the direction that the strabismic eye deviates, the direction of deviation may be assessed. ''Exotropic'' is outwards (away from the midline) and ''esotropic'' is inwards (towards the nose); these are types of horizontal strabismus. "Hypertropia" is upward, and "Hypotropia" is downward; these are types of vertical strabismus, which are less common.

A simple screening test for strabismus is the Hirschberg test. A flashlight is shone in the patient's eye. When the patient is looking at the light, a reflection can be seen on the front surface of the pupil. If the eyes are properly aligned with one another, then the reflection will be in the same spot of each eye. Therefore, if the reflection is not in the same place in each eye, then the eyes aren't properly aligned.

Laterality

Strabismus may be classified as unilateral if the same eye consistently 'wanders', or alternating if either of the eyes can be seen to 'wander'. Alternation of the strabismus may occur spontaneously, with or without subjective awareness of the alternation. Alternation may also be seen following the cover test, with the previously 'wandering' eye remaining straight while the previously straight eye is now seen to be 'wandering' on removal of the cover. The cover-uncover test is used to diagnose the type of strabismus (also known as tropia) present.

Onset

Strabismus may also be classified based on time of onset, either ''congenital'', ''acquired'' or ''secondary'' to another pathological process, such as cataract. Many infants are born with their eyes slightly misaligned. The best time for physicians to assess this is between ages 3 and 6 months.

Differential diagnosis

Pseudostrabismus is the false appearance of strabismus. It generally occurs in infants and toddlers whose bridge of the nose is wide and flat, causing the appearance of strabismus. With age, the bridge of the child's nose narrows and the folds in the corner of the eyes go away. To detect the difference between pseudostrabismus and strabismus, a Hirschberg test may be used.

Management

As with other binocular vision disorders, the primary therapeutic goal for those with strabismus is comfortable, single, clear, normal binocular vision at all distances and directions of gaze.

Whereas amblyopia (lazy eye), if minor and detected early, can often be corrected with use of an eyepatch on the dominant eye and/or vision therapy, the use of eyepatches is unlikely to change the angle of strabismus. Advanced strabismus is usually treated with a combination of eyeglasses or prisms, vision therapy, and surgery, depending on the underlying reason for the misalignment. Surgery does not change the vision; it attempts to align the eyes by shortening, lengthening, or changing the position of one or more of the extraocular eye muscles and is frequently the only way to achieve cosmetic improvement. The procedure can typically be performed in about an hour, and requires about a week for recovery. Double vision can result, and occasionally vision loss can occur. Glasses affect the position by changing the person's reaction to focusing. Prisms change the way light, and therefore images, strike the eye, simulating a change in the eye position.

Early treatment of strabismus and/or amblyopia in infancy can reduce the chance of developing amblyopia and depth perception problems. Most children eventually recover from amblyopia by around age 10, if they have had the benefit of patches and corrective glasses.

Eyes that remain misaligned can still develop visual problems. Although not a cure for strabismus, prism lenses can also be used to provide some comfort for sufferers and to prevent double vision from occurring.

Botulinum Toxin (Botox) may also be used in the treatment of strabismus, to improve cosmetic appearance. Most commonly used in adults, the toxin is injected in the stronger muscle, causing temporary paralysis. The treatment may need to be repeated 3–4 months later once the paralysis wears off. Common side effects are double vision, droopy eyelid, over correction and no effect. The side effects will resolve fairly quickly.

In adults with previously normal alignment, the onset of strabismus usually results in double vision (diplopia).

Prognosis

When strabismus is congenital or develops in infancy, it can cause amblyopia, in which the brain ignores input from the deviated eye. The appearance of strabismus may also be a cosmetic problem. One study reported that 85% of adult strabismus patients "reported that they had problems with work, school and sports because of their strabismus." The same study also reported that 70% said strabismus "had a negative effect on their self-image."

See also

Orthoptist

Duane syndrome

Möbius syndrome

Orthoptics

International Orthoptic Association

Pediatric ophthalmology

Retinoblastoma

Palsy of cranial nerve III (oculomotor), IV (trochlear), VI (abducens)

Strabismus surgery

Amblyopia

Bates method

References

External links

NHS "Lazy Eye" Site – information about lazy eye (amblyopia) and strabismus (squint)

Practical approach to diagnosis of strabismus

Have fun with strabismus – information, demonstration graphics, strabismus surgery

Category:Disorders of ocular muscles, binocular movement, accommodation and refraction

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Coordinates	0°23′24″N9°27′0″N
Currentteam	Houston Texans
Currentnumber	11
Currentposition	Quarterback
Birth date	May 11, 1983
Birth place	Santa Ana, California
Heightft	6
Heightin	5
Weight	232
Debutyear	2006
Debutteam	Arizona Cardinals
Highlights	2× Archie Griffin Award Winner (2003, 2004) Heisman Trophy Winner (2004) Manning Award Winner (2004) Johnny Unitas Award Winner (2004) 2× NCAA QB of the Year (2004, 2005) AP National Champion (2003, 2004) Walter Camp Award Winner (2005)
College	Southern California
Draftyear	2006
Draftround	1
Draftpick	10
Pastteams	Arizona Cardinals (–) Houston Texans (–present)
Statweek	17
Statseason	2010
Statlabel1	Pass attempts
Statvalue1	595
Statlabel2	Pass completions
Statvalue2	340
Statlabel3	Percentage
Statvalue3	57.1
Statlabel4	TD-INT
Statvalue4	14-20
Statlabel5	Passing yards
Statvalue5	3,893
Statlabel6	QB Rating
Statvalue6	70.8
Nfl	LEI453701 }}

Matthew Stephen Leinart (born May 11, 1983), is an American professional football quarterback for the Houston Texans of the National Football League. Leinart previously played for four seasons (2006–2009) with the Arizona Cardinals, largely in a backup role to the now-retired Kurt Warner, before being released on September 4, 2010.

Leinart played collegially at the University of Southern California. In 2004, he led the Trojans to the BCS national championship and was named that year's winner of the Heisman Trophy as well as the winner of the inaugural Manning Award, which is awarded to the country's top quarterback. The championship was vacated by the BCS on June 6, 2011.

The left-handed passing Leinart was selected tenth overall in the 2006 NFL draft by the Arizona Cardinals. Despite possessing what draft experts believed was a good frame for a quarterback (6'-5”, 230 pounds), they believed his lack of a strong throwing arm, such as that possessed by his predecessor, Carson Palmer (now with the Cincinnati Bengals), would be a detriment in his professional career.

After Kurt Warner's retirement, Leinart was named the presumptive starter. However, he lost the starting job in training camp to veteran Derek Anderson, who signed with the Cardinals as a free agent before the 2010 season.

After some speculation, Leinart agreed to a one-year deal with the Houston Texans on September 6, 2010.

Early years

Matt Leinart was born in Santa Ana, California. He was born with strabismus (“crossed eyed”), as his left eye was not aligned correctly with his right. He underwent surgery when he was three years old and was fitted with special glasses to correct the problem, but the eyewear combined with Leinart's already-overweight frame made him an easy target for ridicule at the hands of other children. “I used to get made fun of for being cross-eyed. It's just a terrible thing because kids are so cruel to the fat kid, to the kid with the glasses. So I turned to sports,” he would later say.

Leinart attended Mater Dei High School and was a student and a letterman in football. As a junior, he led his team to a California Interscholastic Federation Division I co-championship, and was named the Serra League's Offensive Most Valuable Player. Wearing number 7, he was chosen as the Gatorade California high school football player of the year.

As one of the nation's top college football recruits, Leinart committed to USC under coach Paul Hackett, noting that a major factor was offensive coordinator Hue Jackson. However, after Hackett and most of his staff were fired in 2000, Leinart considered other programs such as Georgia Tech and Arizona State and visited Oklahoma before USC eventually hired Pete Carroll.

College career

Leinart redshirted in 2001. As a freshman the next year he understudied senior quarterback Carson Palmer, who went on to win the Heisman Trophy and join the Cincinnati Bengals. Leinart appeared in only a few plays in 2002 and threw no passes.

As a sophomore in 2003 Leinart beat out Matt Cassel, a redshirt junior who backed up Palmer in 2002, and Purdue transfer Brandon Hance for the starting job at quarterback. Going into the season, Carroll and his coaching staff selected Leinart not because he had set himself significantly ahead of the pack in practice, but because they needed a starting quarterback. When the coaching staff told Leinart he would be the starter, he replied, "You're never going to regret this." There was some thought in the press that Leinart would merely hold the starting position until highly-touted true freshman John David Booty, who had bypassed his senior year in high school to attend USC, could learn the offense.

His first career pass was a touchdown against Auburn. Leinart would win the first three games of his career before the then-No. 3 Trojans suffered a 34–31 triple-overtime defeat at California on September 27 that dropped the Trojans to No. 10.

Leinart and the Trojans bounced back the next week against Arizona State. Leinart injured his knee in the second quarter and was not expected to play again that day, but he returned to the game and finished 12-of-23 for 289 yards in a 37–17 victory.

Leinart and the Trojans won their final eight games and finished the regular season 11–1 and ranked No. 1 in the AP and coaches' polls. However, USC was left out of the BCS championship game after finishing third in the BCS behind Oklahoma and LSU. The Trojans went to the Rose Bowl and played University of Michigan. Leinart was named the Rose Bowl MVP after he went 23-of-34 for 327 yards, throwing three touchdowns and catching a touchdown of his own. The Trojans finished No. 1 in the AP Poll, winning the AP national championship.

In 13 starts, Leinart was 255 for 402 for 3,556 yards and 38 TDs with 9 INTs. He finished sixth in the Heisman voting.

Junior and Senior seasons

The Trojans started Leinart's junior season (2004) with victories in their first three games. On September 25, the Trojans played Stanford University. After Stanford took a 28–17 halftime lead, Leinart sparked the offense with a 51-yard pass to Steve Smith and scored on a one-yard sneak to cut the Cardinal lead to four points. Leinart and the Trojans were able to take the lead on a LenDale White touchdown rush and hold on for the victory, 31–28. Leinart completed 24 of 30 passes.

He finished the final regular season game against UCLA, but was held without a touchdown pass for the first time in 25 starts. Nonetheless, Leinart was invited to New York for the Heisman ceremony, along with teammate Reggie Bush, Oklahoma's freshman sensation Adrian Peterson, incumbent Jason White, and Utah's Alex Smith. In what many had considered one of the more competitive Heisman races, Leinart became the sixth USC player to claim the Heisman Trophy.

In 2004, USC went wire-to-wire at No. 1 in the polls and earned a bid to the BCS title game at the Orange Bowl against Oklahoma, which was also 12–0. A dream matchup on paper (including White vs. Leinart, which was to be the first time two Heisman winners would play against each other), the Orange Bowl turned out to be a rout, as Leinart threw for five touchdown passes on 18-for-35 passing and 332 yards to lead the Trojans to a 55–19 victory. Leinart received Orange Bowl MVP honors and the Trojans claimed their first BCS national championship and second straight No. 1 finish in the AP, extending their winning streak to 22 games. This victory and BCS championship was vacated as a result of the Reggie Bush scandal.

The 2005 Trojans again had a perfect 12–0 regular season. Against Notre Dame, Leinart threw for a career-high 400 yards. After an incomplete pass and a sack led to a fourth-and-nine situation with 1:36 left—at the Trojans' own 26-yard line, Leinart called an audible "slant and go" route at the line of scrimmage and threw deep against the Irish's man-to-man coverage, where Dwayne Jarrett caught the ball and raced to the Irish' 13-yard line, a 61-yard gain. Leinart moved the ball to the goal line as time dwindled and scored on a QB sneak that gave the Trojans a 34–31 lead with three seconds to go, giving the Trojans their 28th straight victory and one of the most memorable and dramatic finishes in the history of the Notre Dame – USC rivalry.

Leinart, who was having arguably a better season than in 2004, was again invited to New York for the Heisman ceremony along with teammate Reggie Bush and Texas quarterback Vince Young. As a former Heisman winner, Leinart cast his first-place vote for Bush, and ended up third in the voting behind Bush (since vacated) and runner-up Young.

The Trojans advanced to the Rose Bowl to face Vince Young and No. 2 Texas in the BCS title game. The title game was considered another "dream matchup." Leinart himself had a great game, going 29-of-40 for a touchdown and 365 yards, but was overshadowed by Young, who piled up 467 yards of total offense and rushed for three touchdowns, including a score with 19 seconds remaining and two-point conversion to put the Longhorns ahead, 41–38. The Trojans lost for the first time in 35 games, and Leinart for just the second time in his 39 career starts.

After graduation, Leinart's #11 jersey was retired at USC.

Career

Leinart finished his college career with 807 completions on 1,245 attempts (64.8% completion percentage) for 10,693 yards and 99 touchdowns with just 23 interceptions. He is USC's all-time leader in career touchdown passes and completion percentage, and is second at USC behind Palmer in completions and yardage. He averaged nearly 8.6 yards per attempt, and averaged only one interception every 54 attempts. He was 37–2 as a starter.

Stats

2003: 255/402 (63.4%) for 3556 yards and 38 TD vs. 9 INT. 32 carries for -62 yards and 0 TD.

2004: 269/412 (65.3%) for 3322 yards and 33 TD vs. 6 INT. 49 carries for -44 yards and 3 TD.

2005: 283/431 (65.7%) for 3815 yards and 28 TD vs. 8 INT. 51 carries for 36 yards and 6 TD.

Professional career

2006 NFL Draft

Leinart was considered one of the top prospects in the 2006 NFL Draft class. Standing 6'5" (1.96 m) and weighing 225 pounds (100 kg) and a left-handed thrower, he was considered the prototypical NFL quarterback in terms of size but with a weak arm.

Leinart was selected tenth overall in the 2006 Draft by the Arizona Cardinals.

{{nfl predraft | height ft = 6 | height in = 5 | weight = 225 | dash = 4.90 | vertical = 36 | broad ft = 9 | broad in = 5 | note = All values from NFL Combine }}

Arizona Cardinals

Leinart was involved in a prolonged holdout with the Cardinals on August 8, 2006. However, on August 14, Leinart agreed to a six-year, $51 million contract, becoming the very last member of the draft to sign a contract, and not before Cardinal Coach Dennis Green said that he had lost his patience. Despite signing late, Leinart played in the second quarter of the exhibition game against the New England Patriots on August 19.

During the fourth week of the NFL season, unofficial sources projected that Leinart would take over as the starting quarterback, due to a poor performance by Kurt Warner in the previous game. During the week, coach Green held a conference and specifically stated that Warner would still start that week's game.

In a November 26 game, he set an NFL rookie record with 405 passing yards in a loss to the 6-10 Minnesota Vikings. His quarterback rating was 74.0. He suffered a sprained left shoulder (throwing arm) in a week 16 win over the San Francisco 49ers. In 11 starts, Leinart threw for 2,547 yards and 11 touchdowns. He finished the season with a 4–7 record.

Leinart opened the 2007 season on Monday Night Football against the San Francisco 49ers as the starting quarterback. After a sequence of quarters in which the offense stalled, Whisenhunt began to insert Warner as a situational quarterback. On October 10, 2007, Leinart suffered a fractured left collarbone after being sacked by St. Louis Rams linebacker Will Witherspoon. Three days later, he was placed on injured reserve, ending his season. In his first 2 NFL seasons, Leinart had suffered two season-ending injuries within a period of 5 sacks. With Warner at the helm for the remainder of the season, the Cardinals mounted a late-season surge and won five of their final 8 games. In 11 starts in 2007, Warner completed 281 of 451 attempts (62.3%) for 3,417 yards, 27 touchdowns, 17 interceptions, and passer rating of 89.8.

In Leinart's second season with Arizona, he started 5 games and completed 53.6% of his passes (60/112) and threw for 647 yards, 5.8 yards per attempt, 2 touchdowns, and 4 interceptions. His passer rating was 61.9. He averaged 129 yards and 0.4 touchdowns per start.

In the 2008 offseason, after he recovered from the injury, Leinart was handed his starting job back, but his hold on the job was tenuous after another strong training camp performance by Warner. Finally, after Leinart threw 3 interceptions within a matter of minutes versus the Oakland Raiders in the third preseason game, Kurt Warner was named the opening-day starter. Leinart picked up only a limited number of snaps in mop-up duty behind Warner. For the 2008 season, he completed 15 of 29 passing attempts (51.7%), 1 touchdown, 1 interception, and a 80.2 passer rating.

In 2009, Leinart continued his role as back-up for Warner, who started all but one regular season game.

In 2010, he was named the presumptive starter after Warner's retirement; however, he lost the starting job in training camp to Derek Anderson. The Cardinals released Leinart on September 4, two days after the final preseason game, in favor of Anderson and rookies Max Hall and John Skelton.

Houston Texans

On September 6, 2010, ESPN's Adam Scheffter reported that Leinart signed a one year contract to back up Matt Schaub with the Houston Texans. He never played a down for Houston for the entire 2010 season.

Personal life

Leinart's son, Cole Cameron Leinart, was born on October 24, 2006 in California. The mother of Leinart's son is former USC women's basketball player Brynn Cameron. Leinart broke up with Cameron before the baby was born. Though they had a dispute over child support early on, they have since settled their differences and Leinart now has a regular schedule for seeing his son.

Television and film appearances

Matt Leinart's most recent appearance was done in support of a long-time friend who will be competing on The Biggest Loser 2010 on its season premiere 21 Sept 2010. He also made an appearance on the May 1, 2006 episode of ''Punk'd'', featuring Ashton Kutcher as the host. He also has appeared in several commercials on television, most notably for ABC's hit-sitcom ''Desperate Housewives''. He also appeared in Nike's "Football is Everything" commercial as the backup quarterback on the sidelines holding a clipboard. He also starred in an NFL Sunday Ticket commercial with the Manning family (Peyton and Eli are surprised that father Archie is helping him with his throwing, only to have Archie say that "he always wanted a lefty"). In 2007, he appeared in the NFL Shop commercial with Steven Jackson and Adam Vinatieri where he threw an Arizona Cardinals throw blanket to a fan who made a diving catch. Most recently, Leinart appeared in a commercial for ''ESPN the Magazine''. He appeared in seven episodes of ''Rome is Burning'' in 2006-07, ''Jimmy Kimmel Live'' after winning BCS title game (2005), and the 2008 film ''The House Bunny''. Leinart also was a diner in a Hell's Kitchen episode on the Fox Network in 2011.

Honors

2004

Heisman Trophy Winner

Rose Bowl MVP

Walter Camp Award

AP player of the year

Touchdown Club Manning Award

Touchdown Club QB of the Year

Victor Award (Player of the Year)

James E. Sullivan Award Finalist

Newport college player of the year

AP All-American first team

Football Coaches All-American first team

ESPN, CSTV, Rivals.com, SI.com, and CFBNews first team All-American

Pac-10 Co-offensive player of the year

ESPN.com player of the year

Rivals.com player of the year

Pre-season All-American

2005

Orange Bowl MVP

Unitas Award

Finalist for Heisman Trophy

All-American Offensive Player

LA Sports Sportsman of the Year

Sporting News Sportsman of the Year

National Championship MVP

2006

Cosmopolitan Fun Fearless Males 2006

ESPN Hottest Male Athlete of the Year

People Magazine 100 Most Beautiful People

10th Pick in the 2006 NFL draft

Career statistics

College

			Passing								Rushing
Season	Team		GP	Comp	Att	Pct	Yds	TD	INT		Att	Yds	TD
2003	USC Trojans		13	255	402	63.4	3,556	38	9		32	-62	0
2004	USC Trojans		13	269	412	65.3	3,322	33	6		49	-44	3
2005	USC Trojans		13	283	431	65.7	3,815	28	8		51	36	6
	Totals		39	807	1,245	64.8	10,693	99	23		132	-70	9

NFL

			Passing									Rushing
Season	Team		GP	Rating	Att	Comp	Pct	Yds	TD	INT		Att	Yds	TD
2006	Arizona Cardinals		12	74.0	377	214	56.8	2,547	11	12		22	49	2
2007	Arizona Cardinals		5	61.9	112	60	53.6	647	2	4		11	42	0
2008	Arizona Cardinals		4	80.2	29	15	51.7	264	1	1		4	5	0
2009	Arizona Cardinals		8	64.6	77	51	66.2	435	0	3		9	-6	0
2010	Houston Texans		0	0	0	0	0	0	0	0		0	0	0
	Totals		29	70.8	595	340	57.1	3,893	14	20		46	90	2

References

External links

Matt Leinart Foundation website

Arizona Cardinals bio

Houston Texans bio

Matt Leinart profile on ESPN.com

Category:1983 births Category:Living people Category:American Roman Catholics Category:People from Santa Ana, California Category:Players of American football from California Category:American football quarterbacks Category:USC Trojans football players Category:Arizona Cardinals players Category:Houston Texans players Category:Heisman Trophy winners Category:Sportspeople from Orange County, California

da:Matt Leinart de:Matt Leinart es:Matt Leinart fr:Matt Leinart lv:Mets Leinarts ja:マット・ライナート simple:Matt Leinart