Strabismus / Cross Eyes


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When vision is normal, both eyes focus on the same area of the environment and send messages to the brain about these two perspectives on the same area. The brain then combines the two images resulting in the three-dimensional image we perceive. Unfortunately, the eyes don’t always work this way.

Strabismus is a condition in which both eyes are not able to look forward and remain aligned as they should. A more common name for this condition is 'cross eyes' or 'squint'. Because one or both eyes cannot maintain the forward pointing position, the affected eye(s) can move in the socket. It can look up, down, right, or left, even if the other eye is looking ahead.

In some cases, the condition can result in the image from one eye being completely disregarded by the brain, which can cause additional vision problems. The good news is that treatment methods are often available for children who have this vision condition.

Types of Strabismus / Cross Eyes

Strabismus can be either constant or intermittent. Constant strabismus is usually more noticeable because the affected eye is constantly moving and rotating. Usually, one eye will be moving while the other remains aligned properly. However, both eyes may still be affected and may take turns being the eye that moves improperly. With intermittent strabismus, the eyes might generally maintain their appropriate position. Under certain conditions, however, they may move improperly. These conditions could include periods of stress or during times of illness.

Additionally, strabismus can be divided into two additional categories: esotropia and exotropia. With esotropia, one of the eyes is going to point inward towards the nose. In exotropia, however, one of the eyes points outward away from the nose.

Any of these types of strabismus can result in the development of amblyopia, sometimes known as “lazy eye.” Because one eye cannot properly focus, the brain begins to ignore messages picked up from that eye’s optic nerve. The result is the child begins to see out of only one eye, which can lead to problems with depth perception and visual acuity.

Causes of Strabismus / Cross Eyes

The specific cause of cross eyes has not been pinpointed yet. However, the problem lies with the six muscles, which control the movement of the eye in different directions. When the eye is working properly, all of these muscles are coordinated in their movement patterns so the eye moves as it should and delivers an accurate image to the brain. If one or more of the muscles fails to operate in coordination with the others, then strabismus may be the result.

What is known is that this condition seems more prevalent in children who already are suffering from a condition that may impair their brain function, such as Down’s syndrome or cerebral palsy. There may also be a genetic connection because strabismus seems to run in families.

Symptoms of Strabismus / Cross Eyes

The first signs of strabismus occur at an early age, usually before the age of four. Parents may notice that their child’s eyes seem to cross or that one eye doesn’t seem to be focusing on the same part of the environment as the other one. Unfortunately, these changes in the positions of the eyes may be only intermittent so parents may dismiss them and not seek medical attention for their child’s condition.

Other symptoms may include squinting in bright light, head tilting as the child tries to force his or her eyes to focus on the same thing, and rubbing of the eyes. The child may also complain of double vision or may have a noticeable lack of depth perception.

Although sometimes infantile, strabismus does sometimes go away as the child matures, most cases do not and can lead to more significant vision problems down the road. Parents should consult an optometrist if they notice any of the above symptoms or if there is a history of cross eyes in their families.

Eye Test & Diagnosis of Strabismus / Cross Eyes

Generally, strabismus is diagnosed through an eye examination. Optometrists recommend that children have an eye exam around three years of age or earlier to spot any type of vision problems because without correction these could lead to learning delays and other complications. Families which have a history of eye problems, including severe farsightedness or nearsightedness, should test the vision of their children even younger.

The optometrist will check the movement of the eyes as part of the examination. If the child does not pass the exam, he or she may be referred to an ophthalmologist. Once the diagnosis is made by the ophthalmologist, treatment options can be discussed.

Treatment for Strabismus / Cross Eye

Most ophthalmologists often recommend less invasive measures first. Corrective lenses are usually the first method that will be used. The lenses will be created to force the non-focusing eye to focus. If amblyopia is already developing, the child may instead have to wear a patch over the good eye in an attempt to force the weaker eye to correct itself. In many cases, these procedures are effective and may provide vision improvement.

When those less invasive measures do not work, eye surgery can be used. The eye surgeon will make an incision in the film covering the eye in order to reach the eye muscles. The muscles will then be repositioned so they work appropriately. As you might expect, the surgery is done with general anesthesia so your child won’t feel any pain during the procedure.

If surgery is required, most ophthalmologists recommend having it done prior to the child starting school. Strabismus / Cross Eyes can make learning difficult and can also make your child self-conscious about his or her condition. The success rate of the surgery is high, although later surgeries may be needed to re-align the muscles again. Plus, the healing time is very quick, especially in young patients.


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