Strabismus
Crossed eyes; Esotropia; Exotropia; Hypotropia; Hypertropia; Squint; Walleye; Misalignment of the eyes
Strabismus is a disorder in which both eyes do not line up in the same direction. Therefore, they do not look at the same object at the same time. The condition is more commonly known as "crossed eyes."
Causes
Six different muscles surround each eye and work "as a team." This allows both eyes to focus on the same object.
In someone with strabismus, these muscles do not work together. As a result, one eye looks at one object, while the other eye turns in a different direction to focus on another object.
When this occurs, two different images are sent to the brain -- one from each eye. This confuses the brain. In children, the brain may learn to ignore (suppress) the image from the weaker eye.
If the strabismus is not treated, the eye that the brain ignores will never see well. This loss of vision is called amblyopia . Another name for amblyopia is "lazy eye." Sometimes lazy eye is present first, and it causes strabismus.
Amblyopia
Amblyopia is the loss of the ability to see clearly through one eye. It is also called "lazy eye. " It is the most common cause of vision problems i...
In most children with strabismus, the cause is unknown. In more than half of these cases, the problem is present at or shortly after birth. This is called congenital strabismus.
Most of the time, the problem has to do with muscle control, and not with muscle strength.
Other disorders associated with strabismus in children include:
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Apert syndrome
Apert syndrome
Apert syndrome is a genetic disease in which the seams between the skull bones close earlier than normal. This affects the shape of the head and fac...
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Cerebral palsy
Cerebral palsy
Cerebral palsy is a group of disorders that can involve brain and nervous system functions, such as movement, learning, hearing, seeing, and thinking...
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Congenital rubella
Congenital rubella
Congenital rubella is a condition that occurs in an infant whose mother is infected with the virus that causes German measles. Congenital means the ...
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Hemangioma
near the eye during infancy
Hemangioma
A hemangioma is an abnormal buildup of blood vessels in the skin or internal organs.
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Incontinentia pigmenti
syndrome
Incontinentia pigmenti
Incontinentia pigmenti is a skin condition passed down through families. It leads to unusual blistering and changes in skin color.
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Noonan syndrome
Noonan syndrome
Noonan syndrome is a disease that can be passed down through families (inherited). It causes many parts of the body to develop abnormally.
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Prader-Willi syndrome
Prader-Willi syndrome
Prader-Willi syndrome is a disease that is present from birth (congenital). It affects many parts of the body. People with this condition feel hung...
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Retinopathy of prematurity
Retinopathy of prematurity
Retinopathy of prematurity (ROP) is abnormal blood vessel development in the retina of the eye. It occurs in infants that are born too early (premat...
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Retinoblastoma
Retinoblastoma
Retinoblastoma is a rare, cancerous tumor of a part of the eye called the retina.
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Traumatic brain injury
Traumatic brain injury
A concussion may occur when the head hits an object, or a moving object strikes the head. A concussion is a minor or less severe type of brain injur...
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Trisomy 18
Trisomy 18
Trisomy 18 is a genetic disorder in which a person has a third copy of material from chromosome 18, instead of the usual 2 copies.
Strabismus that develops in adults can be caused by:
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Botulism
Botulism
Botulism is a rare but serious illness caused by Clostridium botulinum bacteria. The bacteria may enter the body through wounds, or by eating them f...
- Diabetes (causes a condition known as acquired paralytic strabismus)
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Graves disease
Graves disease
Graves disease is an autoimmune disorder that leads to an overactive thyroid gland (hyperthyroidism). An autoimmune disorder is a condition that occ...
-
Guillain-Barré syndrome
Guillain-Barré syndrome
Guillain-Barré syndrome is a serious health problem that occurs when the body's defense (immune) system mistakenly attacks part of the nervous system...
- Injury to the eye
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Shellfish poisoning
Shellfish poisoning
This article describes a group of different conditions caused by eating contaminated fish and seafood. The most common of these are Ciguatera poison...
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Stroke
Stroke
A stroke occurs when blood flow to a part of the brain stops. A stroke is sometimes called a "brain attack. " If blood flow is cut off for longer th...
- Traumatic brain injury
- Vision loss from any eye disease or injury
A family history of strabismus is a risk factor. Farsightedness may be a contributing factor, often in children. Any other disease that causes vision loss may also cause strabismus.
Farsightedness
Farsightedness is having a harder time seeing object that are close than things that are far away.
Symptoms
Symptoms of strabismus may be present all the time, or may come and go. Symptoms can include:
- Crossed eyes
- Double vision
- Eyes that do not aim in the same direction
- Uncoordinated eye movements (eyes do not move together)
- Loss of vision or depth perception
It is important to note that children may never be aware of double vision. This is because amblyopia can develop quickly.
Exams and Tests
The health care provider will do a physical exam . This exam includes a detailed examination of the eyes.
Physical exam
During a physical examination, a health care provider studies your body to determine if you do or do not have a physical problem. A physical examinat...
The following tests will be done to determine how much the eyes are out of alignment.
- Corneal light reflex
- Cover/uncover test
- Retinal exam
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Standard ophthalmic exam
Standard ophthalmic exam
A standard ophthalmic exam is a series of tests done to check your vision and the health of your eyes.
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Visual acuity
Visual acuity
The visual acuity test is used to determine the smallest letters you can read on a standardized chart (Snellen chart) or a card held 20 feet (6 meter...
A brain and nervous system (neurological) exam will also be done.
Treatment
The first step in treating strabismus in children is to prescribe glasses, if needed.
Next, amblyopia or lazy eye must be treated. A patch is placed over the better eye. This forces the weaker eye to work harder and get better vision.
Your child may not like wearing a patch or eyeglasses. A patch forces the child to see through the weaker eye at first. However, it is very important to use the patch or eyeglasses as directed.
Eye muscle surgery may be needed if the eyes still do not move correctly. Different muscles in the eye will be made stronger or weaker.
Eye muscle repair surgery does not fix the poor vision of a lazy eye. Muscle surgery will fail if amblyopia has not been treated. A child may still have to wear glasses after surgery. Surgery is more often successful if done when the child is younger.
Muscle surgery
Eye muscle repair is surgery to correct eye muscle problems that cause strabismus (crossed eyes).
Adults with mild strabismus that comes and goes may do well with glasses. Eye muscle exercises may help keep the eyes straight. More severe forms will require surgery to straighten the eyes. If strabismus has occurred because of vision loss, the vision loss will need to be corrected before strabismus surgery can be successful.
Outlook (Prognosis)
After surgery, the eyes may look straight, but vision problems can remain.
The child may still have reading problems in school. Adults may have a hard time driving. Vision may affect the ability to play sports.
In most cases, the problem can be corrected if identified and treated early. Permanent vision loss in one eye may occur if treatment is delayed. If amblyopia is not treated by about age 11, it is likely to be permanent. About one-third of children with strabismus will develop amblyopia.
Vision loss
There are many types of eye problems and vision disturbances, such as: HalosBlurred vision (the loss of sharpness of vision and the inability to see ...
Many children will get strabismus or amblyopia again. Therefore, so the child will need to be monitored closely.
When to Contact a Medical Professional
Strabismus should be evaluated promptly. Call your provider or eye doctor if your child:
- Appears to be cross-eyed
- Complains of double vision
- Has difficulty seeing
Note: Learning and school problems can sometimes be due to a child's inability to see the blackboard or reading material.
References
Cibis GW, Ing M. Binocular vision. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology 2013 ed . Philadelphia, PA: Lippincott Williams & Wilkins; 2013:vol 1, chap 5.
Goldstein HP, Scott AB. Ocular motility. In: Tasman W, Jaeger EA, eds. Duane's Foundations of Clinical Ophthalmology 2013 ed . Philadelphia, PA: Lippincott Williams & Wilkins; 2013:vol 2, chap 23.
Magill AJ, Hill DR, Solomon T, Ryan ET. Poisonous plants and aquatic animals. In: Magill AJ, Hill DR, Solomon T, Ryan ET, eds. Hunter's Tropical Medicine and Emerging Infectious Diseases . 9th ed. Philadelphia, PA: Elsevier; 2013:chap 133.
Olitsky SE, Hug D, Plummer LS, Stahl ED, Ariss MM, Lindquist TP. Disorders of eye movement and alignment. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; 2016:chap 623.
Parks MM. Binocular vision adaptations and maldevelopments monofixation syndrome, microstrabismus, and macrostrabismus. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology 2013 ed . Philadelphia, PA: Lippincott Williams & Wilkins; 2013:vol 1, chap 8.
Strabismus. American Association for Pediatric Ophthalmology and Strabismus. Updated March 28, 2014. www.aapos.org/terms/conditions/100 . Accessed September 2, 2016.
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Crossed eyes - illustration
People are very sensitive to other individuals' eye positions. By looking at another person's eye position, one can very effectively gauge where they are looking. People are also sensitive to eyes that are not looking in the same direction, which is referred to as crossed eyes (strabismus). Other more specific medical terms refer to eyes turned either outward or inward, or that are abnormally rotated. Any appearance of crossed eyes in young children should be immediately evaluated, as should recent onset of crossed eyes in an adult.
Crossed eyes
illustration
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Walleyes - illustration
People are very sensitive to other individuals' eye positions. By looking at another person's eye position, one can very effectively gauge where they are looking. People are also sensitive to eyes that are not looking in the same direction, which is referred to as crossed eyes (strabismus). Other more specific medical terms refer to eyes turned either outward or inward, or that are abnormally rotated. Any appearance of crossed eyes in young children should be immediately evaluated, as should recent onset of crossed eyes in an adult.
Walleyes
illustration
-
Crossed eyes - illustration
People are very sensitive to other individuals' eye positions. By looking at another person's eye position, one can very effectively gauge where they are looking. People are also sensitive to eyes that are not looking in the same direction, which is referred to as crossed eyes (strabismus). Other more specific medical terms refer to eyes turned either outward or inward, or that are abnormally rotated. Any appearance of crossed eyes in young children should be immediately evaluated, as should recent onset of crossed eyes in an adult.
Crossed eyes
illustration
-
Walleyes - illustration
People are very sensitive to other individuals' eye positions. By looking at another person's eye position, one can very effectively gauge where they are looking. People are also sensitive to eyes that are not looking in the same direction, which is referred to as crossed eyes (strabismus). Other more specific medical terms refer to eyes turned either outward or inward, or that are abnormally rotated. Any appearance of crossed eyes in young children should be immediately evaluated, as should recent onset of crossed eyes in an adult.
Walleyes
illustration
Review Date: 8/20/2016
Reviewed By: Franklin W. Lusby, MD, ophthalmologist, Lusby Vision Institute, La Jolla, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.