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Strabismus

Topic Overview

What is strabismus?

Anatomy of the eye

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.

What causes strabismus?

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 tumour, Graves' disease, stroke, and various muscle and nerve disorders can also cause strabismus in adults.

What are the symptoms?

The most common signs are:

  • Eyes that don't look in the same direction at the same time. (If your child's eyes are only slightly misaligned, you may not notice.)
  • Eyes that don't move together.
  • Squinting or closing one eye in bright sunlight.
  • Tilting or turning the head to look at an object.
  • Bumping into things. (Strabismus limits depth perception.)

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.

How is strabismus diagnosed?

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 time.

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 has 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.

How is it treated?

The most common treatments for strabismus are:

  • Glasses. Wearing glasses can sometimes correct mild strabismus.
  • A temporary eye patch over the stronger eye if your child has amblyopia. This can make the weak eye stronger, which may help align the eyes. Your child may have to wear the patch some or all of the time for a few weeks or months.
  • Surgery on the eye muscles. This is often the only way to improve vision and better align the eyes. It may take more than one surgery, and your child may still need to wear glasses.

Other treatments may include medicines and eye exercises.

Treatment for 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.

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  Amblyopia: Wearing an Eye Patch

Other Places To Get Help

Organizations

Canadian Ophthalmological Society
610-1525 Carling Avenue
Ottawa, ON  K1Z 8R9
Email: cos@eyesite.ca
Web Address: www.cos-sco.ca
 

The Canadian Ophthalmological Society is an association of eye doctors dedicated to helping the public take good care of their eyes and vision. This group provides educational information on eye conditions and diseases and eye safety.



Canadian Paediatric Society
2305 Saint Laurent Boulevard
Ottawa, ON  K1G 4J8
Phone: (613) 526-9397
Fax: (613) 526-3332
Email: To contact the CPS via email, go to www.cps.ca/en/about-apropos/staff.
Web Address: www.cps.ca
 

The Canadian Paediatric Society (CPS) promotes quality health care for Canadian children and establishes guidelines for paediatric care. The organization offers educational materials on a variety of topics, including information on immunizations, pregnancy, safety issues, and teen health.



Related Information

References

Citations

  1. 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.

Credits

By Healthwise Staff
John Pope, MD - Pediatrics
Anne C. Poinier, MD - Internal Medicine
Christopher J. Rudnisky, MD, MPH, FRCSC - Ophthalmology
Last Revised April 3, 2013
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