Strabismus - FAQ

What is strabismus?

Strabismus is a condition of misalignment of the eyes, which is commonly known as crossed eyes. Strabismus occurs when the eyes do not line up with each other, and thus do not look in the same direction. Strabismus can occur in one or both eyes, and in any direction. Each eye has six extraocular muscles, which are eye muscles that work together to move the eyes horizontally, vertically or torsionally. Strabismus can result when the extraocular muscles either overwork or underwork, which causes the eye to become misaligned. A child may consistently tilt or turn his or her head to compensate for their misaligned eyes.

What are risk factors for strabismus?

Strabismus occurs in approximately two to four percent of the pediatric population. The most common risk factors include a family history of strabismus and low birth weight, especially those with a history of an eye condition called retinopathy of prematurity or those with previous neurologic complications. Other conditions associated with strabismus include corneal scars, congenital cataracts, drooping of the eyelid known as ptosis, brain injury, and rarely a tumor in the eye known as a retinoblastoma.

 Why is it important to detect strabismus early?

There is a time during an infant’s development known as the critical period, which is a period of visual maturation when the visual system is affected by outside influences. These influences are critical to the development of normal vision, which reaches the adult level by age three to five years of age. If visual development during this critical period is impaired due to strabismus, a child can develop amblyopia (also known as a lazy eye). This may severely affects the child’s ability to see. It is also important to detect strabismus early in order to rule out life threatening conditions such as a tumor in the eye known as a retinoblastoma.

Which conditions can mimic strabismus?

Unsteady ocular alignment, which may resemble strabismus, is normal in newborns during the first few months of life and thus does not represent true strabismus. Pseudostrabismus, which may also resemble strabismus, is an optical illusion where a child’s wide nasal bridge or folds around the eye make the eye appear crossed; however, pseudostrabismus does not represent true strabismus. Your ophthalmologist will determine if your child has true strabismus versus another condition.

 What should I do as a parent or caregiver for my child?

It is important to take your child to his or her regular health maintenance exams with your pediatrician at three, four and five years of age. Your child will be referred to an ophthalmologist if his or her pediatrician determines that they have a history and physical exam findings suggestive of strabismus. The ophthalmologist will perform additional tests to determine the etiology, type and severity of your child’s strabismus.

How is strabismus treated?

The treatment for strabismus depends on the underlying etiology. The ultimate goal for treatment of strabismus is improved alignment of the eyes. Your ophthalmologist may treat your child’s strabismus with prescribed eyeglasses with or without prisms, patching the better-seeing eye, using eye drops to blur the vision of the better-seeing eye, visual training exercises, or rarely surgery to correct structural abnormalities and/or the activity of the extraocular muscles.

What are the complications of strabismus?

Amblyopia, also known as a lazy eye, can occur in up to fifty percent of children with untreated strabismus. Double vision, also known as diplopia, can also occur, especially in children with strabismus older than three years old. Limited eye movement and adverse psychosocial consequences can also be seen in children with strabismus.