15/12/2025
Strabismus (Crossed Eyes)
By Dr. Christian (OD)
What Is Strabismus?
Strabismus, commonly called "crossed eyes," is a vision condition where the eyes fail to align properly and point in different directions. While one eye looks straight ahead, the other may turn inward, outward, upward, or downward. This misalignment stems from poor eye muscle control or nerve signal problems that prevent the eyes from working together as a coordinated team.
Strabismus is particularly common in children and can be present at birth (congenital) or develop later in childhood or even adulthood. Without proper treatment, it can lead to serious complications including amblyopia (lazy eye), loss of depth perception, and permanent vision problems.
Causes of Strabismus
Muscle and Nerve Dysfunction: The primary cause involves problems with the six muscles controlling each eye or the brain's ability to send proper signals to these muscles, resulting in poor coordination.
Refractive Errors: Significant uncorrected farsightedness (hyperopia) can trigger eye turning as the child struggles to focus, particularly esotropia (inward turning).
Neurological and Medical Conditions: In adults, strabismus may result from stroke, traumatic brain injury, cerebral palsy, or systemic diseases like diabetes, thyroid disorders, myasthenia gravis, or botulism.
Genetic Factors: Family history of strabismus increases risk, suggesting hereditary components.
Other Risk Factors: Premature birth, low birth weight, developmental delays, Down syndrome, and certain congenital conditions can increase susceptibility.
Types of Strabismus
By Direction:
- Esotropia: Inward turning (crossed eyes)
- Exotropia: Outward turning (wall-eyed)
- Hypertropia: Upward turning
- Hypotropia: Downward turning
By Pattern:
- Constant: Eye misalignment present all the time
- Intermittent: Misalignment occurs only sometimes, often when tired or focusing on distant objects
- Unilateral: Always affects the same eye
- Alternating: Switches between eyes
Symptoms and Warning Signs
Visible Indicators:
- Obvious misalignment of one or both eyes
- Eyes appearing to look in different directions
- Uncoordinated eye movements
Functional Symptoms:
- Double vision (diplopia), especially in adults or older children
- Difficulty with depth perception and judging distances
- Eye strain or fatigue
- Difficulty reading or focusing on tasks
Compensatory Behaviors:
- Head tilting or turning to align vision
- Squinting or closing one eye, particularly in bright sunlight
- Poor hand-eye coordination
Complications:
- Amblyopia (Lazy Eye): The brain begins suppressing images from the misaligned eye to avoid confusion, leading to permanently reduced vision in that eye if untreated
- Loss of Binocular Vision: Inability to use both eyes together eliminates stereoscopic (3D) vision
- Psychosocial Impact: Can significantly affect self-esteem, social interactions, and quality of life in children and adults
Treatment Options
Non-Surgical Treatments:
Corrective Lenses: Glasses or contact lenses correct underlying refractive errors that may be contributing to or causing the strabismus.
Eye Patching (Occlusion Therapy): Covering the stronger eye forces the brain to use the weaker, misaligned eye, preventing or treating amblyopia.
Vision Therapy: Structured eye exercises and activities strengthen eye muscles, improve coordination, and train the brain to use both eyes together effectively.
Prism Lenses: Special glasses that bend light to help align images and reduce double vision.
Botulinum Toxin Injections: Temporary weakening of overactive eye muscles to improve alignment in select cases.
Surgical Treatment:
Eye Muscle Surgery: The most definitive treatment for moderate to severe strabismus. The surgeon adjusts the position or tension of eye muscles to realign the eyes. May require one or multiple procedures for optimal results. Success rates are generally high, especially when combined with other therapies.
Treatment Approach: Often involves a combination of methods tailored to the individual's age, type of strabismus, and severity. Early intervention is crucial for best outcomes, particularly in children.
When to See a Doctor
Immediate Evaluation Needed:
- Any persistent eye misalignment in infants beyond 3-4 months of age (intermittent crossing in newborns up to 3 months can be normal)
- Sudden onset of eye turning or double vision in children or adults
- Eye misalignment following head injury or illness
Schedule an Appointment If:
- You notice any consistent eye turning in a child of any age
- Frequent squinting, head tilting, or eye closing
- Complaints of double vision or difficulty seeing
- Family history of strabismus or amblyopia
- Any concerns about your child's vision development
Important Note: Early detection and treatment are critical. The younger a child is when treatment begins, the better the chances of developing normal vision and eye coordination. Regular pediatric eye exams are essential for catching strabismus and other vision problems early.
Strabismus is a treatable condition, but success depends heavily on timely intervention. With proper diagnosis and a comprehensive treatment planâwhether through glasses, patching, vision therapy, or surgeryâmost people with strabismus can achieve improved eye alignment, better vision, and enhanced quality of life. Don't hesitate to consult an eye care professional if you have any concerns about eye alignment in yourself or your child.
