Treatment and Complications of Strabismus | Ophthalmology


What is strabismus?

Crossed eyes, also known as strabismus, occur when the eyes are improperly designed and point in different directions. Strabismus can occur at any age, but it is most common in infants and young children. It can be found in 5 percent of children and affects boys and girls equally.

Normally, the muscles connected to each eye work together to move both eyes in the same direction at the same time. Strabismus happens when the eye muscles do not work correctly to control eye movements. When the eye muscles do not work, the eyes may be misaligned and the brain may not be able to integrate what one eye sees with what the other eye sees.

A child rarely develops strabismus after it has developed. Without treatment, strabismus can cause permanent vision problems. For example, if a child does not use an eye because it is improperly designed, he or she may develop poor vision in that eye (called a lazy eye or amblyopia).


  • Eyes that look misaligned
  • Eyes that do not move together
  • Frequent blinking or squinting, especially in bright sunlight
  • Tilting the head to look at things
  • Faulty depth perception
  • Double vision


There are several types of strabismus, but more broadly they can be divided into the following groups:

  • Esotropia: Esotropia is convergent strabismus in which one eye turns towards the nose.
  • Exotropia: Exotropia is divergent strabismus in which one eye turns outward.
  • Hypertropias: Also known as vertical deviation, hypertropia is a form of strabismus in which one eye is turned upward toward the eyebrows. This is a much less common form of strabismus.
  • Paralytic strabismus: Lack of blood can cause damage to the third, fourth, or sixth cranial nerve, pressure on nerves or head injury, and limited eye movements.


It is usually caused by a defect in the part of the brain that controls eye movement. It is less common due to a defect in the muscles that control the movement of the eyes.

Other conditions:

  • Uncorrected refractive errors
  • Poor vision in one eye
  • Cerebral palsy
  • Down syndrome (20-60% of these patients are affected)
  • Hydrocephalus (a congenital condition that occurs in the development of fluid in the brain)
  • Brain tumors
  • Stroke (the leading cause of strabismus in adults)
  • Head injuries, which can harm the area of the brain is responsible for the control of eye movement, the nerves that control eye movement, and the eye muscles
  • Neurological (nervous system) problems
  • Graves’ disease (overproduction of thyroid hormone)

Diseases that affect partial or total blindness can cause strabismus. Therefore, extreme vision, cataracts, eye injuries, or one eye may have a better vision than another.

Risk factors

You’re more likely to receive crossed eyes if you:

  • Have family members who have crossed eyes
  • Have a brain disorder or brain tumor
  • Have had a stroke or brain injury
  • Have a tired eye, are farsighted, or have vision loss
  • Have a damaged retina
  • Have diabetes


Regular eye exams are the best way to diagnose strabismus. Usually, the child is diagnosed and treated for previous strabismus after an eye exam and the result is more successful. Without treatment, your child may develop double vision, amblyopia, or visual symptoms that interfere with reading and learning in the classroom.

It is important to note that children do not outgrow strabismus, so diagnosis and treatment by eye care professionals are important. There are successful treatments and treatment options for some types of strabismus, including non-surgical options.

The exam may include the following:

  • Patient history: To identify patient symptoms, family history, general health problems, medications used, and other causes of symptoms.
  • Visual acuity: Reading letters on the eye chart or observing a child’s visual behavior.
  • Refraction: Checking them with correction lenses to measure how the eyes focus light. Children do not have to be old enough to give verbal feedback when checking glasses.
  • Alignment and vision tests
  • Exam after student enlargement (width) to determine the health of the internal structures of the eye


There are several treatment options for crossed eyes. They include:

Eyeglasses or Contact Lenses: If your child suffers from strabismus due to uncorrected vision, the optometrist may prescribe glasses to correct the vision. Some patients may also benefit from prism lenses, which change the light entering the eye and thus help control the eye’s rotation.

Prism Lenses: In prism lenses, one is deeper than the other. Prisms reduce eye turn by changing the light that enters an object. Prisms sometimes completely eliminate eye roll.

Vision Therapy: Your ophthalmologist can prescribe a variety of visual activities that can improve your eye coordination and vision. These eye exercises reduce problems with vision and eye movement and improve the connection between the eye and the brain for effective visual equipment. These eye exercises can also be performed at home.

Eye Muscle Surgery: The length or position of the eye muscle can be made directly visible by eye muscle surgery. Generally, vision therapy is prescribed to patients after surgery, to prevent the eyes from turning wrong again and to improve eye coordination.


When the eyes focus on two different areas, the brain receives two different images. To do this, your baby’s brain ignores the image of the crossed eye and only processes the image of the strong eye. It affects your deep understanding. It can also cause amblyopia or lazy eye. This happens when the crossed eye does not develop good eyesight or loses vision. One-third of children with strabismus develop amblyopia.


After surgery, the eyes look straight, but vision problems persist. Children can still have reading problems in school. Adult driving is very difficult. Vision affects the ability to play sports.

In most cases, early detection and treatment can correct the problem. Permanent loss of vision can occur in one eye if treatment is delayed. If amblyopia is not treated before age 11, it is more likely to be permanent. One-third of children with strabismus develop amblyopia.

Most children re-develop strabismus or amblyopia. Therefore, the child must be closely monitored.

When to contact the doctor

You should speak with your child’s healthcare professional as soon as possible about any concerns about the child’s ability to see or the alignment of his eyes. A pediatric ophthalmologist should diagnose a child with persistent strabismus at any age or intermittent strabismus after 3 months of age.

An adult who develops double vision or other signs of strabismus should see their healthcare professional for further evaluation.

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