Know the basics
What is strabismus?
Strabismus, also known as “crossed-eyes,” is a condition in which the eyes don’t line up in the same direction. They appear to point in different directions. One or both eyes may turn either in or out. Over time, the weaker eye becomes “lazier” or less used, as the brain uses signals from the stronger eye. Without early treatment, strabismus may make you lose some vision.
How common is strabismus?
Strabismus usually common in children. It can also occur later in life. For children, strabismus usually occurs at birth but will not be diagnosed until at least 3 months old. For adults, diseases such as diabetes, stroke or eye injury can also cause strabismus. Please discuss with your doctor for further information.
Know the symptoms
What are the symptoms of strabismus?
Symptoms of strabismus may be present all the time, or may come and go. Signs and symptoms may include:
- Crossed eyes;
- Double vision;
- Eyes that do not align in the same direction;
- Uncoordinated eye movements (eyes do not move together);
- Loss of vision or depth perception.
It is important to note that children may never have double vision because amblyopia can develop quickly.
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
When should I see my doctor?
Strabismus should be evaluated promptly. Call your doctor or eye doctor if your child:
- Appears to be cross-eyed;
- Complains of double vision;
- Has difficulty seeing.
Sometimes learning problems at school can sometimes be due to a child’s inability to see the blackboard or reading material. If the teacher have informed you of learning issues, it is best to get your child’s eyes checked.
Know the causes
What causes strabismus?
Normally, there are six different muscles surrounding each eye that work together. This allows both eyes to focus on the same object at the same time.
In someone with strabismus, these muscles do not work together. As a result, one eye looks at one object, while the other eye turns in a different direction to focus on another object.
When this occurs, two different images are sent to the brain — one from each eye. This confuses the brain. In children, the brain may learn to ignore the image from the weaker eye.
If the strabismus is not treated, the eye that the brain ignores will never see well. This loss of vision is called amblyopia. Another name for amblyopia is “lazy eye.” Sometimes amblyopia is present first, and it causes strabismus.
In most children with strabismus, the cause is unknown. In more than half of these cases, the problem is present at or shortly after birth. This is called congenital strabismus.
Most of the time, the problem has to do with muscle control, and not with muscle strength.
Other disorders associated with strabismus in children include:
- Apert syndrome (a genetic disorder that affects the growth of the skull);
- Cerebral palsy (a neurological disorder that affects muscle control);
- Congenital rubella;
- Hemangioma (noncancerous growth of the blood vessels) near the eye during infancy;
- Incontinentia pigmenti syndrome (a rare genetic disorder that affects the skin);
- Noonan syndrome (a rare genetic disorder that affects the facial appearance);
- Prader-Willi syndrome (genetic condition that causes weak muscle tone);
- Retinopathy of prematurity (disorder affecting the eye);
- Retinoblastoma (a rare cancer of the retina);
- Traumatic brain injury;
- Trisomy 18 (a genetic disorder that causes birth defects).
Strabismus that develops in adults can be caused by:
- Diabetes (causes a condition known as acquired paralytic strabismus);
- Graves’ disease;
- Guillain-Barré syndrome;
- Injury to the eye;
- Shellfish poisoning;
- Traumatic brain injury;
- Vision loss from any eye disease or injury.
A family history of strabismus is a risk factor. Farsightedness may be a contributing factor, especially in children. Any other disease that causes vision loss may also cause strabismus.
Know the risk factors
What increases my risk for strabismus?
Some common risk factors of strabismus may include:
- Family history. If you have a family member that has strabismus, there are high chances you or your child will have strabismus.
- Genetic disorders. There are many genetic disorders associated with strabismus.
- Premature births. Babies born prematurely are more at risk to have strabismus.
- There are many disorders associated with strabismus. These may include cerebral palsy, stroke, and Down syndrome. You can find more disorders mentioned under causes.
Understand the diagnosis & treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How is strabismus diagnosed?
To give you a proper diagnosis, your doctor may perform the following tests:
- Physical exam that includes a detailed eye examination;
- Brain and neurological exam;
- Corneal light reflex;
- Cover/uncover test;
- Retinal exam;
- Standard eye exam;
- Visual acuity.
How is strabismus treated?
The first step in treating strabismus in children is to prescribe glasses, if needed.
Next, amblyopia or lazy eye must be treated. A patch is placed over the better eye. This forces the weaker eye to work harder and get better vision.
Your child may not like wearing a patch or eyeglasses. A patch forces the child to see through the weaker eye at first. However, it is very important to use the patch or eyeglasses as directed.
Eye muscle surgery may be needed if the eyes still do not move correctly. Different muscles in the eye will be made stronger or weaker.
Eye muscle repair surgery does not fix the poor vision of a lazy eye. Muscle surgery will fail if amblyopia has not been treated. A child may still have to wear glasses after surgery. Surgery is more often successful if done when the child is younger.
Adults with mild strabismus that comes and goes may do well with glasses and eye muscle exercises to help keep the eyes straight. More severe forms will require surgery to straighten the eyes. If strabismus has occurred because of vision loss, the vision loss will need to be corrected before strabismus surgery can be successful.
Lifestyle changes & home remedies
What are some lifestyle changes or home remedies that can help me manage strabismus?
The following lifestyles and home remedies might help you cope with strabismus:
- Eye exercises are recommended by your eye doctor to strengthen and balance the eye.
- Using an eye patch to cover the good eye will help strengthen the weak eye.
- Special eyeglasses may be recommended to correct the vision.
- Manage the chronic stress in your life.
- Exercise and maintain a healthy diet.
If you have any questions, please consult with your doctor to better understand the best solution for you.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Ferri, Fred. Ferri’s Netter Patient Advisor. Philadelphia, PA: Saunders / Elsevier, 2012. Print edition. Page 727.
Porter, R. S., Kaplan, J. L., Homeier, B. P., & Albert, R. K. (2009). The Merck manual home health handbook. Whitehouse Station, NJ, Merck Research Laboratories. Print edition. Page 1818.
Strabismus. https://www.nlm.nih.gov/medlineplus/ency/article/001004.htm. Accessed July 13, 2016.
Strabismus. http://www.naturaleyecare.com/eye-conditions/strabismus/. Accessed July 13, 2016.
Review Date: January 4, 2017 | Last Modified: January 4, 2017