Vision depth and precision depend on two eyes focusing on the same thing at the same time. When one eye isn't in partnership with the other, it's known as strabismus. (Learn more)

An eye doctor can diagnose strabismus as part of a routine eye exam. (Learn more) You won't need a special test or a specialist's help to determine if this condition is impacting your eyesight.

If you have strabismus, your doctor can use special eyeglasses, eye patches, or surgery to correct the issue. Treatment is important, as this condition won't go away on its own. (Learn more)

What Is Strabismus?

Multiple muscles control eye movement. They all tug together to rotate your eye up, down, in, or out to help you focus on the images you want to see. When those muscles don't coordinate their efforts, the eyes can point in different directions. This is strabismus.

The American Academy of Ophthalmology reports that strabismus symptoms can look different throughout the day. Eyes can switch roles, so one may be aligned in the morning and turned in an unusual way during the afternoon. The turn of the eye can also shift, so it may point in differing directions.

You may notice that your eye wanders when you:

  • Focus on objects in the distance. The eye may turn outward when you scan the horizon. You may also experience this when you're driving.
  • Stand in the sunlight. You may squint just one eye when you're exposed to bright light.
  • Are tired. A long reading session can fatigue your eyes, and movement may happen at that time.
  • Look at something close to your face. Images may seem blurred unless you close one eye.

The Prevent Blindness organization says about 2 percent of children have strabismus, and often, it's present at birth. But children can also show symptoms of the condition when they really don't have it at all. Babies are born with wide noses and a bit of extra skin around the eyes. These two attributes can make a baby's eyes seem misaligned, but with growth and time, the eyes develop an evenness.

If the misalignment is true and persists, it's vital for parents to ask for help. We once believed that kids would outgrow the problem as they age, but doctors now know it will get worse without treatment. The American Optometric Association says children older than 4 months with crooked-seeming eyes should have an exam to rule out strabismus.

Children with untreated strabismus can grow into adults with a vision deficiency in one eye. The brain becomes confused at the two focal points it is shown, and it learns to ignore the images from one eye. This can be treated, but prevention is a better tactic. Prompt treatment in childhood ensures that the brain doesn't make this shift.

Adults can also develop strabismus even if they never had it as children. It can be caused by the following conditions:

  • Stroke
  • Traumatic brain injury
  • Diabetes
  • Botulism
  • Guillain-Barre syndrome
  • Grave’s disease
  • Shellfish poisoning
  • Eye disease or injury

Strabismus Diagnosis

woman with question mark on forehead

Your mirror can help you understand if you have strabismus. As you look straight ahead into the glass, you may see one eye shifting off in an unusual direction. You may also notice blurred or double vision since your eyes are focused on different things.

These are just observations, not diagnostic details. But they can prompt you to visit an eye doctor, and there, a test can help to confirm strabismus.

Your eye doctor will dilate your eyes with drops, which makes the back of your eye easier to examine. When your eyes are fully dilated, your doctor will shine a light into your eyes. The eyes should reflect that light in the same way, with rays pointing in the same direction. If not, a strabismus diagnosis is appropriate.

Strabismus is also associated with vision problems, including farsightedness. Your doctor will check your visual acuity during the exam to ensure that this isn't contributing to the pointing problem in your eyes.

This test isn't painful, and it doesn't take your doctor long to complete. Once you have a diagnosis, you can get started on therapies to help you see better.

types of strabismus

How Strabismus Is Treated

There are a variety of different approaches your doctor can use to help you overcome strabismus. The option that's right for you depends on your age, your overall health, and your personal preferences. Your doctor can help you make the right choice.

Your doctor might suggest:

  • Glasses. Strabismus can worsen with strain, and if you've skipped correction for a vision issue, that can make your eyes work harder. A proper prescription could be a big help.
  • Prism lenses. These specialized lenses for glasses bend the light as it enters your eye. Your muscles won't work so hard to move your eye, and that could ease your symptoms.
  • Patches. Placing a patch over one eye could help to soothe overtaxed muscles and reinforce connections within your brain.
  • Injections. A shot of botulinum toxin type A can weaken muscles that are working too hard, says the Cleveland Clinic. That injection could bring symmetry to eye muscles.
  • Exercises. Muscles can be trained to work in harmony. Your doctor might ask you to move your eyes in a coordinated manner several times per day.

family with happy kids

These treatments should help your eyes to work together, but your doctor will need to monitor your progress to make sure they're helping. You might have frequent visits to the office to talk with your doctor, and at each visit, your doctor might dilate your eyes and check your progress. It's important to keep every appointment, so your doctor can monitor how well your eyes are responding.

If these steps don't work, surgery might. An eye surgeon can tighten up loose muscles that control the eye. That could help them pull in partnership with their companions, and your eye misalignment could fade.

The American Association for Pediatric Ophthalmology and Strabismus says there's no age limit for this surgery. Even people 90 and older can benefit from surgical treatment for this condition. In most cases, insurance will cover this surgery. It's not a cosmetic condition. It's an issue that will impact your ability to see, so this is considered a functional correction.

It might seem unusual to have surgery for something that seems simply bothersome. That might be especially true if you've lived with strabismus your whole life. But it's important to remember that this isn't just a cosmetic concern.

Your brain can make adjustments that cut off communication with one eye. You'll lose depth perception, and that can limit your ability to do all sorts of things safely. Driving, cooking, knitting, and more could all become impossible for you.

If you are living with strabismus, talk with your doctor about what therapies are right for you.

References

What Is Strabismus? (April 2014). American Academy of Ophthalmology.

Strabismus. Prevent Blindness.

Strabismus (Crossed Eyes). American Optometric Association.

Strabismus. (March 2019). U.S. National Library of Medicine.

What's to Know About Squint, or Strabismus? (March 2017). Medical News Today.

Strabismus (Crossed Eyes): Management and Treatment. (January 2019). Cleveland Clinic.

Adult Strabismus. (November 2016). American Association for Pediatric Ophthalmology and Strabismus.