Strabismus (Misaligned Eyes)

Strabismus is a condition in which both eyes do not point in the same direction. Approximately 4% of the U.S. population is affected. While it may run in families, strabismus can also be associated with conditions such as cerebral palsy, Down syndrome, hydrocephalus, or brain tumors.

Types of Eye Misalignment

Esotropia: Eyes turn inward. Subtypes include infantile esotropia, accommodative esotropia (related to farsightedness), and sixth nerve palsy.

Exotropia: Eyes turn outward.

Vertical misalignments: Eyes are misaligned up or down.

Strabismus can develop in children and adults, and in most cases, proper treatment can improve eye alignment.

Symptoms of Strabismus

*Sudden double vision may indicate a more serious neurologic condition. Seek immediate medical attention if this occurs.

Tests for Strabismus

A complete eye exam is the first step in determining the severity and best treatment. Testing may include:

Visual Acuity

Reading letters (or pictures for very young children) to assess vision.

Motility Exam

Checking eye alignment and muscle function.

Refraction

Using corrective lenses to determine the appropriate prescription for nearsightedness, farsightedness, or astigmatism.

Treatments

Eyeglasses or Contact Lenses: Special lenses can help straighten the eyes in some cases.

Prism Lenses: Prescription glasses with prism power can improve alignment.

Patching: Covering the stronger eye for a few hours each day forces the weaker eye to work harder, improving vision and alignment over time.

Medications: Atropine eye drops can temporarily blur vision in the stronger eye, helping the weaker eye strengthen.

Eye Muscle Surgery: If other treatments are insufficient, surgery can weaken or strengthen eye muscles to realign the eyes. Early surgery is most successful in establishing binocularity – the ability of both eyes to focus together to create a single image.

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FAQ

What is strabismus, and how does it impact everyday life?

Strabismus, often called crossed eyes or lazy eye, occurs when the eyes don’t align properly and point in different directions—one might turn inward, outward, up, or down. This misalignment prevents the brain from fusing images from both eyes into a single clear picture, which can lead to double vision, poor depth perception, or even permanent vision loss in the weaker eye if untreated, especially in children. It’s more than a cosmetic issue; it can affect reading, sports, or driving, making simple tasks frustrating, but the good news is that with early detection, most cases can be corrected to restore comfortable, single vision.

What causes strabismus in children versus adults?

In kids, strabismus often stems from uncorrected refractive errors like farsightedness, muscle imbalances at birth, or neurological factors such as cerebral palsy—it’s present in about 4% of children and can run in families. Adults might develop it suddenly from injury, stroke, thyroid eye disease, or even stress on eye muscles from prolonged screen time. Unlike kids, where the brain is still adaptable, adults may notice immediate double vision, highlighting why prompt evaluation is crucial regardless of age to prevent compensatory habits like head tilting.

How is strabismus diagnosed, and what tests are involved?

Diagnosis starts with a fun, non-invasive eye exam where the doctor checks alignment using lights or toys to see if eyes team up properly—kids might cover one eye while playing, while adults do similar with prisms. Additional tests include refraction for glasses needs, dilated pupil exams to rule out underlying issues, and sometimes visual field mapping. It’s straightforward and painless, often revealing if amblyopia (lazy eye) is also at play, so treatment can be comprehensive from the start.

What are the treatment options for strabismus?

Treatments are tailored by age and severity: for mild cases, glasses or eye patches strengthen the weaker eye and encourage alignment, while vision therapy exercises train muscles like physical therapy for the eyes. If those aren’t enough, adjustable surgery repositions eye muscles under brief anesthesia—outpatient for most, with kids recovering in days. Botox injections offer a temporary fix for adults, relaxing overactive muscles. Success rates are high (80-90%), and many patients enjoy straight eyes and better binocular vision post-treatment.

Can strabismus be prevented, and what does long-term management look like?

While not always preventable, regular pediatric eye screenings from infancy catch it early, and correcting refractive errors promptly helps. For adults, managing conditions like diabetes reduces risks. Long-term, some need occasional glasses tweaks or follow-up surgeries as eyes change, but most maintain alignment with simple habits like limiting screen strain. If you’re concerned for a child, starting with an optometrist referral can make all the difference—straight eyes mean clearer views of the world.