Strabismus (misaligned eyes) is a condition in which your eyes don’t line up with one another. In other words, one eye is turned in a direction that’s different from the other eye.
Under normal conditions, the six muscles that control eye movement work together and point both eyes in the same direction. If you have strabismus, these muscles have issues controlling eye movement and can’t keep normal ocular alignment (eye position).
While strabismus is mainly found in childhood, adults can also experience strabismus. Most commonly, strokes cause ocular misalignment in adults. Another cause is physical trauma. But you can be an adult with childhood strabismus that wasn’t treated or was treated and has come back (recurred) or gotten worse.
Closing one eye when looking at objects that are far away or when you’re in bright light.
When do the symptoms of strabismus appear?
Strabismus usually appears in infants and young children, and most often by the time your child is 3 years old.
But it’s normal for your newborn to have misaligned or wandering eyes from time to time. By the age of 3 to 4 months, your baby’s eyes should be able to focus on small objects and they should be straight and well-aligned. A 6-month-old baby should be able to focus on objects both near and far.
The sudden appearance of strabismus — especially with double vision — in an older child or adult could indicate a more serious neurologic disorder. If you or your older child develop misaligned eyes or it happens suddenly, call a healthcare provider right away.
Pseudostrabismus
A condition called pseudostrabismus (false strabismus) makes it look like your baby has misaligned eyes when they really don’t. This can happen because your baby has extra skin that covers the inner corners of their eyes or their nasal bridge is flat. As your baby’s face develops and grows, their eyes won’t look misaligned anymore.
How is strabismus treated?
There is a variety of treatment options for strabismus. Your eye care provider will discuss which options are best for your specific situation. Treatment options include:
Eyeglasses or contact lenses: If you have uncorrected refractive errors, corrective lenses may help your eyes remain straight, as they’ll need less effort to focus.
Prism lenses: Special lenses that can bend light entering your eye to relieve double vision.
Orthoptics (eye exercises): May work on some types of strabismus, especially convergence insufficiency (a form of exotropia).
Medications: Eye drops, ointments or injections of botulinum toxin type A (like Botox®) can weaken an overactive eye muscle. These treatments may be used with — or in place of — surgery, depending on your situation.
Patching: To treat amblyopia, if you have it at the same time as strabismus. Improving vision may also improve control of eye misalignment.
Eye muscle surgery (strabismus surgery): Surgery changes the length or position of eye muscles so your eyes are aligned correctly. This is performed under general anesthesia with dissolvable stitches. Sometimes, adults are offered adjustable strabismus surgery, where the eye muscle positions are adjusted after surgery.
You’ll need to see your provider for follow-up to see if you’ve responded to treatments. Your provider will make any needed adjustments.
How is strabismus diagnosed?
Any child older than 4 months who appears to have strabismus should have a complete eye examination by a pediatric ophthalmologist, with extra time spent examining how their eyes focus and move. The exam may include the following:
Medical history (to determine their symptoms, family history, general health problems, medications being used and any other possible causes of symptoms).
Visual acuity (reading letters from an eye chart or examining young children’s visual behavior).
Refraction (checking their eyes with a series of corrective lenses to measure how they focus light). Children don’t have to be old enough to give verbal feedback when checking for glasses.
Alignment and focus tests.
Examination after dilating (widening) their pupils to determine the health of internal eye structures.
Other factors to consider that help determine the cause and treatment of strabismus:
Did the problem come on suddenly or over time?
Was it present in the first 6 months of life or did it occur later on?
Does it always affect the same eye or does it switch between eyes?
Is the degree of turning small, moderate or large?
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