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Strabismus is misalignment of the eyes. The eyes may appear to cross, or one eye may wander to the side. Strabismus is sometimes called crossed eyes or wall-eyed.
About 4 percent of the U.S. population has strabismus. Left untreated, strabismus can lead to amblyopia or permanent vision loss in children.
The four most common types of strabismus are:
- Esotropia. This is an inward crossing of the eyes.
- Exotropia. This is an outward turning of the eye or wall-eyed.
- Hypotropia. This is an abnormal eye that sits lower than the normal eye.
- Hypertropia. This is an abnormal eye that sits higher than the normal eye.
When a child has two healthy eyes, the eye muscles work together to focus on the same object at the same time. The brain combines the two pictures into a single, three-dimensional image, and this image gives us depth perception.
With strabismus, the muscles do not work together. Each eye focuses in a different place. As a result, two different images are sent to the brain. The brain may begin to ignore the weaker eye. If strabismus continues and vision loss in the weaker eye progresses, it can lead to a condition called amblyopia or lazy eye. About one-third of children with strabismus will develop amblyopia.
The cause of most children’s strabismus is unknown, but family history can be a factor.
Symptoms of Strabismus
Symptoms can always be present or come and go. A newborn’s eye may cross or wander. Even if this only happens occasionally, tell your pediatrician if it occurs after your child is 3 months of age. You may notice these symptoms of strabismus in a child as well:
- Crossed eyes
- Double vision (more common in adults than children)
- Eyes that do not align in the same direction
- Uncoordinated eye movements (eyes do not move together)
- Loss of vision or depth perception
- Using one eye and closing the other
- Looking at objects with the head turned to one side
- One eye that squints in bright sunlight
Diagnosis of Strabismus
At Riley at IU Health, an ophthalmologist will conduct a complete eye examination of both eyes. Tests may include:
- Corneal light reflex
- Cover/uncover test
- Retinal exam
- Visual acuity
These tests can determine how much the eyes are out of alignment.
Treatments
Treatments
If identified and treated early, strabismus can be corrected. The goal of strabismus treatment is to improve eye alignment and allow the eyes to work together better.
An ophthalmologist may fit your child with eyeglasses or suggest eye exercises. Patching or atropine eye drops may be used to treat amblyopia or lazy eye. When the stronger eye is patched or treated with eye drops, it can force the weaker eye to get stronger.
Eye muscle surgery also may be needed, but it will not correct poor vision in a lazy eye. Problems associated with strabismus like lazy eye, ptosis and cataracts are usually treated before surgery. Glasses, patching or other treatment for lazy eye may still be needed after surgery. If amblyopia is not treated by about age 11, it can be permanent.
Many children will have strabismus or amblyopia more than once. This is why an ophthalmologist should monitor your child’s vision for months or even years.
Key Points to Remember
Key Points to Remember
- Strabismus is misalignment of the eyes.
- Left untreated, strabismus can lead to amblyopia (lazy eye) and permanent vision loss in children.
- Symptoms of strabismus include crossed eyes, eyes that do not align in the same direction and uncoordinated eye movements.
- The earlier strabismus is identified and treated, the better. It can be corrected.
- Many children have strabismus or amblyopia more than once, so continued monitoring is necessary.
Support Services & Resources
Support Services & Resources
Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.
The American Academy of Ophthalmology is the largest national membership association of eye doctors. Parents and caregivers can use their website to learn more about the diagnosis and treatment of strabismus.
Strabismus Research
Strabismus Research
Our physicians are committed to excellence in pediatric ophthalmology care, demonstrated through participation in research at the Indiana University School of Medicine. Recent research explores the use of intraocular lens and secondary Artisan lens implants in children as a treatment for cataracts, new drugs to treat glaucoma, new therapies for macular degeneration and treatment of strabismus. We have also completed research in molecular biology of the chemical cycle of vision, neurophysiology of eye movements and physiology of blood flow in the eye.
Locations
Locations
Locations
In addition to our primary hospital location at the Academic Health Center in Indianapolis, IN, we have convenient locations to better serve our communities throughout the state.
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