Strabismus

Definition

Strabismus is a misalignment of one or both eyes. It prevents both eyes from focusing on the same point at the same time. Prompt treatment is needed to avoid vision problems, including blindness.

The names associated with strabismus are based on the type, and direction and appearance of the eye.

Strabismus can be:

• Constant—the eye turns all the time
• Intermittent—the eye turns only some of the time, like in times of stress, illness, concentration, or when tired

Direction of the eye:

• Hyper—eye turns upward
• Hypo—eye turns downward
• Exo—eye turns outward (away from the nose)
• Eso—eye turns inward (toward the nose)

Appearance of the eye:

• Tropia—can be seen when both eyes are open
• Phoria—can be seen only when one eye is covered

Exotropia of the Left Eye.

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Causes

Eye movement is a coordination of muscles and nerves that support the eye. Strabismus is normal in infants (up to about 4 months of age) until the eyes straighten out. It can be present at birth or develop during the course of childhood. Some causes of strabismus include:

• Visual problems with the eyes, like cataracts or farsightedness
• Problems with the muscles and/or nerves that support the eyes
• Trauma (more likely in adults)
• Tumors (rarely)

In most cases, the cause of strabismus is unknown.

Risk Factors

Strabismus is most common in children, but it may occur in adults. Other factors that may increase the chances of strabismus:

• Family members with strabismus
• Diabetes
• Thyroid disorders
• Retinopathy of prematurity
• Vision impairment in one eye—the affected eye will often turn in or out

Symptoms

Strabismus may cause:

• Crossed eyes
• Eyes that do not align properly
• Uncoordinated eye movements
• Double vision
• Problems with depth perception
• Eye strain, which may cause headaches or blurred vision
• Squinting
• Favoring a certain head position

Many aspects of strabismus are noticed by other people.

Diagnosis

The doctor will ask about any symptoms, and medical and family history. A physical exam will be done. In general, misalignments of the eye can be seen. An eye specialist will test the eyesight and look for other abnormalities. A neurological exam can help rule out other causes.

Treatment

Treatment may include:

Prevention

There are no current guidelines to prevent strabismus. If you notice that you or your child’s eyes are not properly aligned, visit their eye doctor right away.