Strabismus (say "struh-BIZ-mus") is a vision problem in which both eyes
do not look at the same point at the same time. Strabismus most often begins in
early childhood. It is sometimes called crossed-eyes, walleye, or squint.
Normally, the muscles attached to each eye work together to move both eyes in
the same direction at the same time. Strabismus occurs when the eye muscles don't work properly to control eye movement. When the eye muscles don't work
as they should, the eyes may become misaligned and the brain may not be able to
merge what one eye sees with what the other eye sees.
A child rarely
outgrows strabismus after it has developed. Without treatment, strabismus can
cause permanent vision problems. For example, if the child is not using one eye
because it is misaligned, he or she can develop poor vision in that eye (called
lazy eye or amblyopia).
Having strabismus can be hard
on your child's self-esteem. It affects your child's appearance as well as his or her ability to see well. Other kids may tease your
child for being cross-eyed or having a walleye. Be supportive of your child,
and seek treatment right away.
Childhood strabismus often
has no known cause, although it tends to run in families.
Sometimes strabismus develops when the eyes
compensate for other vision problems, such as
farsightedness or a cataract. Other things that can increase your child's risk for strabismus include an illness that affects the muscles and nerves, premature birth, Down syndrome, a head injury, and other problems.
Adults may develop
strabismus from eye or blood vessel damage. Loss of vision, an eye tumour or a brain
stroke, and various muscle and nerve disorders can
also cause strabismus in adults.
most common signs are:
An older child may also complain about blurred vision, tired eyes, sensitivity to light, or double vision.
Symptoms may come and go. They may get worse when your child is tired or sick.
A newborn's eyes may be
misaligned at first. But the eyes should become aligned by 3 to 4 months of age. In some
cases, the eyes may simply seem to be misaligned because the child has a wide
bridge of the nose that creates the appearance of crossed eyes. But if your child's eyes aren't aligned all
of the time after age 4 months, take your child to the doctor for an eye examination.
A doctor can often
tell that a child has strabismus just by looking at the child's eyes. It may be
obvious that the eyes don't look in the same direction at the same
The doctor may have the child look at an object while
covering and then uncovering each eye. This allows the doctor to see
which eye turns, how much it turns, and under what circumstances the abnormal
turn occurs. These tests will also help the doctor find out if the child
amblyopia (lazy eye), which sometimes occurs with strabismus.
The Canadian Paediatric Society recommends screening to detect lazy eye (amblyopia), misaligned eyes (strabismus), and defects in visual acuity in children younger than 5 years of age.1 But no child is too young for an eye examination. If you have concerns about your child's eyes or vision at any age, take him or her to an eye doctor.
The most common treatments for
Other treatments may include medicines and eye exercises.
strabismus should begin as soon as
possible. In general, the younger the child is when treatment begins, the better the chances are of correcting the problem.
It's also important for your child to get follow-up examinations.
Health Tools help you make wise health decisions or take action to improve your health.
Learning about strabismus:
Community Paediatrics Committee, Canadian Paediatric Society (2009). Vision screening in infants, children and youth. Paediatrics and Child Health, 14(4): 246–248. Also available online: http://www.cps.ca/english/statements/CP/cp09-02.htm.
Other Works Consulted
American Academy of Ophthalmology Pediatric Ophthalmology/Strabismus Panel (2012). Esotropia and exotropia. (Preferred Practice Pattern). San Francisco: American Academy of Ophthalmology. Also available online: http://one.aao.org/CE/PracticeGuidelines/PPP_Content.aspx?cid=689e7270-36c6-4daf-9dab-f6b1ab7286d3.
American Academy of Ophthalmology Pediatric Ophthalmology/Strabismus Panel (2012). Pediatric eye evaluations. (Preferred Practice Pattern). San Francisco: American Academy of Ophthalmology. Also available online: http://one.aao.org/CE/PracticeGuidelines/PPP_Content.aspx?cid=2e30f625-1b04-45b9-9b7c-c06770d02fe5.
American Optometric Association (2011). Care of the patient with strabismus: Esotropia and exotropia. Optometric Clinical Practice Guideline. Available online: http://www.aoa.org/x4813.xml.
Enzenauer RW, et al. (2011). Strabismus. In CD Rudolph et al., eds., Rudolph's Pediatrics, 22nd ed., pp. 2293–2298. New York: McGraw-Hill.
Motley WW, Asbury T (2011). Strabismus. In P Riordan-Eva, ET Cunningham, eds., Vaughan and Asbury's General Ophthalmology, 18th ed., pp. 238–258. New York: McGraw-Hill.
Trobe JD (2006). Strabismus. In Physician's Guide to Eye Care, 3rd ed., pp. 137–139. San
Francisco: American Academy of Ophthalmology.
ByHealthwise StaffPrimary Medical ReviewerJohn Pope, MD - PediatricsAnne C. Poinier, MD - Internal MedicineSpecialist Medical ReviewerChristopher J. Rudnisky, MD, MPH, FRCSC - Ophthalmology
Current as ofSeptember 9, 2014
Current as of:
September 9, 2014
John Pope, MD - Pediatrics
& Anne C. Poinier, MD - Internal Medicine & Christopher J. Rudnisky, MD, MPH, FRCSC - Ophthalmology
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