Crossed Eyes: Understanding Strabismus and How to Treat It

Strabismus, the medical term for misaligned or “crossed" eyes, is a condition found in about 3% to 5% of the population in the United States.¹ Strabismus is more common in children, but can happen at any stage of life.¹ Read on to find out more about what strabismus is, its causes, treatments and more.

What Is Strabismus?

Strabismus is a condition in which one or both eyes point in a different direction than the other. We have six muscles that connect to each eye and control its movements. These muscles receive signals from our brain to move the eyes around, and typically our eyes move together as directed. But when there is an issue with eye movement control, one or both eyes may turn in, up or down. This is strabismus.²

If strabismus happens suddenly in a child or adult, it can indicate a neurological disorder and you should seek medical care right away.³ In adults, strabismus can occur after a stroke or physical trauma.³ The important thing to note is that strabismus will not go away on its own — if left untreated, it will continue to worsen and may result in permanently reduced vision.²

Strabismus is sometimes confused with two other conditions: amblyopia (lazy eye)¹ and nystagmus (dancing eyes).

Strabismus in newborns and children

Strabismus most often occurs in infants and young children under three years old. While it's normal for a newborn's eyes to wander sometimes, an infant's eyes should be straight and able to focus on small objects by the time they are three to four months old.³

Types of Strabismus

There are three common types of strabismus:³

• Accommodative esotropia often occurs when there is a family history of the condition and in situations of uncorrected farsightedness. The extra effort needed to focus on distant objects can cause the eyes to turn inward.
• Intermittent exotropia is when one eye focuses on a target and the other eye turns outward. That eye may alternate looking straight and turning outward.
• Infantile esotropia occurs in infants less than six months old who show significant inward turning of both eyes, requiring surgery on the muscles of one or both eyes to correct.

Additionally, some optometrists define strabismus by the direction in which the eye points or how it acts:³

• Esotropia: Eye points inward.
• Exotropia: Eye points outward.
• Hypertropia: Eye points upward.
• Hypotropia: Eye points downward.
• Constant or intermittent: How often the eye wanders
• Unilateral or alternating: Whether it's always in the same eye or alternates eyes

Causes of Strabismus

Strabismus isn't usually caused by a problem with the actual eye muscle — it's typically related to the neuromuscular control of your eye movement from your brain. There are several risk factors that may increase the chances of someone developing strabismus:³

• Family history: About 30% of children with strabismus have a family member with the condition.
• Uncorrected farsightedness
• Medical conditions like cerebral palsy, Down syndrome, Graves' disease or nervous system problems
• Stroke
• Brain tumors
• Head injury

Symptoms of Strabismus

Symptoms of strabismus are both physical and vision-related. Someone may experience a combination of these symptoms:³

• Eyes that look misaligned or crossed²
• Eyes that don't move together²
• Tilting or turning the head when focusing on an object
• Closing or covering one eye when focusing on something or in bright sunlight
• Difficulty reading
• Double vision
• Headaches
• Eye strain

Diagnosing Strabismus

An optometrist can diagnose strabismus through a comprehensive eye exam that includes:²

• Patient health and vision history
• Eye health (examining the internal and external structures of the eye)
• Visual acuity (using the eye chart)
• Refraction (determining the appropriate prescription to compensate for a refractive error: nearsightedness, farsightedness or astigmatism)
• Alignment and focus testing

Treatment for Strabismus

As previously mentioned, strabismus will not go away on its own and can cause further vision complications if left untreated. If detected early, strabismus can often be corrected with one or more treatment options:²

• Eyeglasses or contact lenses. Sometimes, this is the only treatment someone will need.
• Prism lenses. These special lenses are thicker on one side than the other, altering the light that enters the eye and reducing the amount of work the eye has to do to focus on objects.
• Vision therapy. Visual activities that improve eye coordination and eye focusing train the eyes and brain to work together more effectively.
• Eye muscle surgery. This procedure addresses the length or position of the muscles around the eyes so they can straighten. Vision therapy is often required post-surgery to maintain results.

Strabismus Treatment Costs

When it comes down to the costs for strabismus treatments, it depends on whether or not you have insurance. You can expect to pay the following amounts:

Preventing Strabismus

Strabismus can't be prevented,² so early detection is key. Children should be screened before the age of six months and again between the ages of three to five years.²

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Author Bio

Abbie Mood is a freelance writer with more than 10 years of experience. She has worked with clients of all sizes to create compelling content and she has written for the American Kennel Club, Marriott Bonvoy, Women's Health Online, Headspace and more.