Pediatric Ophthalmology

Strabismus

For Parents

Be sure to contact your eye care professional if your child develops crossing or wandering of one eye, double vision or complains of problems seeing in the distance and/or for near.

UW Health's pediatric eye care services professionals are devoted to the medical and surgical treatment of childhood eye disease and adult strabismus (eye muscle problems).

What is strabismus?

Strabismus is the term used when the two eyes do not line up in the same direction. Common terms include crossed eyes, squint or wandering eyes.

What causes strabismus?

Strabismus occurs when there is lack of coordination between the eyes.  There may be a defect of fusion (blending of images seen by each eye into one image) or of motor control (failing to keep the eyes aligned).

In children, strabismus might be observable shortly after birth or in early infancy. This is known as congenital strabismus. One eye may wander in, out, up or down relative to the other eye.

A more frequent cause of crossing of the eyes, esotropia, is the need for the eyes to focus blurry images. This focus effort; known as accommodation, is a trigger for the eyes to converge or turn in toward one another and if excessive, becomes an uncontrolled crossing in of one eye.

An outward drifting of one eye is exotropia. Often the drifting is only noted when the child is tired or not feeling well.  It can be accompanied by closing of one eye (squinting), especially when in bright sunlight.

Whenever one eye does not line up with the other, two things are seen at one time and the brain must choose which eye to "pay attention" to. When the brain ignores one eye consistently, that eye can lose its clear vision and can lead to significant and serious loss of vision. This condition is known as amblyopia.

When strabismus occurs in adults, it often presents suddenly and may be associated with underlying medical, trauma, or neurological disease.

What are the symptoms of strabismus? 

A family history of eye misalignment is a risk factor and should alert the family to have a thorough eye exam even if no symptoms are present.

Signs that might alert you or your child to the presence of strabismus include:

  • Visible misalignment of one eye during visual tasks
  • Eyes that do not move together
  • Double vision
  • Poor vision in one eye when compared to the other eye

How is strabismus treated?

In order to determine the best plan of treatment, a thorough examination of the eyes must be performed. This will include a determination of whether there is a need for glasses to provide clear vision without excessive effort to focus. It will be necessary to dilate the eyes with eye drops during the examination process. Following dilation, the eye doctor also will be able to look for possible signs of eye disease and determine if more testing is needed.

Treatments options for strabismus can include glasses, prism lenses, patching (for amblyopia), eye exercises and surgery. The goal of treatment for patients with strabismus and amblyopia is to provide adequate alignment of the eyes to allow for the development of fusion, good and equal vision in each eye and comfortable single binocular vision.