Crossed Eyes: Strabismus

Strabismus refers to misaligned or crossed eyes. If the eyes turn inward, it is called an esotropia. If the eyes turn outward, it is called an exotropia. Additionally, one eye can be aligned higher than the other and this is called a hypertropia. A hypotropia is an eye that is aligned lower than it should be. The crossing of the eyes can be occurring occasionally or it can be there all the time. Strabismus can affect only one eye, both eyes or can shift back and forth between the eyes.

This condition usually begins as a baby or in early childhood. Adults can develop strabismus after a head trauma, brain tumor removal or stroke. Some children have an accommodative esotropia or inward crossing of both eyes due to their high farsightedness and need for glasses. The true cause of strabismus is still not fully understood, but is believed to develop due to the eye muscles inability to work together simultaneously. Research has shown that school age children with severe strabismus often have self-image problems due to the misalignment of their eyes.

As a child, strabismus usually does not cause any visual symptoms that your child will complain about. An abnormal head tilt to one side or closing an eye when the eye turns may be noticed. However, the child's brain often ignores the vision in the eye that is turned and suppresses its vision. This is both good and bad. It is good because the brain does not allow the child to have double vision from the misalignment of eyes, but is bad because the brain will learn to suppress the vision and not use the eye. This can lead to gradual vision loss in that eye which is called ambylopia. This loss of vision can be mild to very severe. The loss of vision does not occur if the child alternates back and forth between their two eyes.

Treatment for strabismus is to first identify the cause. Some children with a mild strabismus may benefit from patching therapy where it may be necessary to patch the good eye to strengthen the other eye. Also wearing glasses may be needed to help correct the condition. Additionally in some cases, using prisms in the glasses may be helpful in aligning small deviations of teh eye muscles. If those treatments do not work, then surgery may be indicated to align the eye muscles together and we will refer your child to a pediatric surgeon who specializes in performing eye muscle surgeries.