Strabismus: Understanding Causes, Symptoms, And Effective Treatment Strategies


Strabismus (misaligned eyes) or crossed eyes is a condition where one eye is turned in a direction that is not the same as the other eye. It is a common problem in kids but could, at times be found in adults also. In simple words, both eyes are not aligned or do not line up with one another. The eyes add to the beauty and are an important sense organ. Strabismus does not affect the sight but it hampers the beauty of the face. Six muscles control the eye movement and make it point in the same direction. Strabismus affects the muscles, and issues occur in controlling eye movement. The eye muscles fail to get a normal ocular alignment.

What are the causes of strabismus?

In most cases, strabismus occurs as there is a problem with neuromuscular control of the eye’s movement. The problem includes eye muscle and brain coordination. There is not much problem with the actual eye muscle. In most cases, it was found that strabismus is a genetic condition. About 30% of children with strabismus had someone in their family with the same ailment. 

symptoms of strabismus

symptoms of strabismus

Strabismus occurs in infants or children by the age of three years. Normally, the newborn has misaligned eyes. However, by the age of three to four months, the baby’s eyes are able to focus on small objects. By this age, they have well-aligned eyes, and both eyes point at the same object. By six months the child is able to focus on objects far and near. 

If suddenly an older child or adult experiences, strabismus especially with double vision, it could imply that there is an underlying neurological issue. In the sudden case of strabismus, one should immediately contact the health care provider.

What are the risk factors that lead to strabismus?

Some of the factors apart from the ones mentioned above that are risk factors for misaligned eyes are as follows?

  • Uncorrected refractive errors
  • Poor vision in one eye
  • Cerebral palsy
  • Down syndrome, as per surveys it was found that 20% to 60% of people with Down syndrome have strabismus.
  • Hydrocephalus is an ailment that results in fluid build-up in the brain.
  • Stroke is the leading cause of strabismus in adults.
  • Brain tumors
  • Neurological problems
  • Head injury or trauma that affects the part of the brain that controls eye movement and the eye muscles.
  • Graves’ disease overproduction of thyroid hormone

Symptoms of strabismus:

  • Double vision
  • Turning of had
  • Headaches
  • Difficulty in reading
  • Eye strain
  • Closing one eye and looking at objects that are far away
  • Closing one eye and looking at bright light.
  • Closing one eye and looking at an object which is nearby.

What is pseudostrabismus?

A condition like pseudostrabismus (fake strabismus) makes it appear that the child has misaligned eyes when they actually don’t have them. The fake condition occurs because the baby has extra skin that forms a layer around the corners of the eyes or the nasal bridge of the child is flat. As the baby grows and their face develops the eyes will not look misaligned.

What are the complications of strabismus?

The myth around strabismus is that people believe that it will get cured once the child grows a little older and the facial muscles develop. The truth, however, is that the problem gets worse if left untreated. If the eyes are not treated properly it could lead to the following:

  • Lazy eye- lazy eye or permanent poor vision in the turned eye. As the eyes look in two directions they send different messages to the brain. The brain tends to ignore the message of the turned eye, and as a result, the vision of the turned eye deteriorates.
  • Blurry vision- the turned eye gets a blurry image, and this affects performance in school and office. 
  • Frequent headaches and nausea
  • Double vision
  • Poor three-dimensional vision
  • Eye strain
  • Getting conscious of looks

Also, there are chances that the health expert may not diagnose a serious health concern like a neurological disorder or tumor that causes strabismus.

How to diagnose and treat strabismus?

In case any child older than four months cannot focus on an object should be examined by a pediatric ophthalmologist. Also, all the children of six months are thoroughly examined by an ophthalmologist. To focus on their eyes and their movement. The exam includes:

  • Medical history to check if anyone in the family had strabismus.
  • Visual activity like focusing on an object and moving the eyes with the object.
  • Alignment tests
  • Refraction to check how the child focuses on the light.
  • Examination after dilating the pupils to check the internal eye structure.

There are multiple treatment options available for treating strabismus. Depending on the situation, the eye care specialist makes the recommendations.

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Some of the best treatment options:

  1. Eyeglasses or contact lenses- in case of uncorrected refractive errors, corrective lenses can help the eyes to point in the same direction. As they will require minimum effort to stay in the same direction.
  2. Orthoptics- in certain cases, strabismus exercises are of immense help. Especially, in the case of exotropia.
  3. Prism lenses- prism lenses can bend the light entering the eyes and thus prove to help in the case of double vision.
  4. Medication- eye drops, ointments, or injections of botulinum toxin type A work to weaken an overactive muscle. The medications are given with or in place of surgery depending on the issue. 
  5. Patching- to treat amblyopia and strabismus together patching is an option. Improved vision could help with improved control of eye misalignment.
  6. Eye muscle surgery- surgery works to change the length or position of the eye muscle so that the eyes are in alignment. For the surgery, general anesthesia is given, and dissolvable stitches are done. 

The earlier the strabismus is detected the easier it gets to cure. In the case of infants to six months old, it is advised to get checked by an ophthalmologist. 


  • Helveston EM. Understanding, detecting, and managing strabismus. Community Eye Health. 2010 Mar;23(72):12-4. [PMC free article]
  • Clarke WN. Common types of strabismus. Paediatr Child Health. 1999 Nov;4(8):533-5. [PubMed]

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Dr. David G Kiely is a distinguished Medical Reviewer and former General Medicine Consultant with a wealth of experience in the field. Dr. Kiely's notable career as a General Medicine Consultant highlights his significant contributions to the medical field.

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