Strabismus (Crossed Eyes): Symptoms, Causes, and Treatment

Strabismus (Crossed Eyes): Symptoms, Causes, and Treatment | Updated 2025

Strabismus, also known as crossed eyes, is a condition in which the eyes are misaligned and unable to focus on the same point at the same time. This misalignment may cause one eye to turn inward, outward, upward, or downward. If not treated early, strabismus can lead to reduced depth perception and even amblyopia (lazy eye).

What Is Strabismus?

Under normal conditions, the eyes work together to focus on a single target. When the eye muscles or the nerves controlling them do not function properly, one eye may drift in a different direction.

Strabismus can be:

• constant or intermittent,
• mild or severe,
• present at birth or developed later in life.

At What Age Does Strabismus Occur?

Strabismus commonly appears between 0 and 4 years of age, but it can also develop in:

• older children,
• teenagers,
• and adults.

Common misconception: “Children outgrow strabismus.”
✔ In reality, untreated strabismus often worsens or becomes permanent.

Strabismus can be categorized based on the direction of eye deviation

• Esotropia refers to the inward turning of the eye.
• Exotropia is characterized by the outward turning of the eye.
• Hypertropia indicates an upward turning of the eye.
• Hypotropia indicates a downward turning of the eye.

Strabismus can also be classified according to other criteria, such as

• The frequency of its occurrence, distinguishing between constant or intermittent manifestations.
• The consistency of the affected eye, identifying as unilateral when it’s always the same eye that is misaligned.
• The variability of the affected eye, known as alternating, if the misalignment shifts between the right and left eye at different times.

Evaluating strabismus involves a comprehensive assessment focusing on eye movement and focusing capabilities, which may encompass

• Detailed Patient History: Gathering extensive background information on vision health, symptoms, and any family history of eye disorders.
• Visual Acuity: Testing the sharpness and clarity of vision in each eye individually to identify any discrepancies or issues.
• Refraction: Determining the eye’s lens strength needed to correct vision by assessing how light rays are bent as they enter the eye.
• Alignment and Focusing Testing: Examining how well the eyes align and focus together, and whether there are issues with eye coordination.
• Examination of Eye Health: A thorough inspection of the eyes and their structures to identify any health problems or anomalies that could contribute to or result from strabismus.

In cases where patients are unable to communicate verbally or when there’s a possibility that some of the eyes’ focusing ability is concealed, doctors might employ the use of eye drops. These drops temporarily paralyze the focusing mechanism of the eye, preventing any adjustments in focus during the examination. This ensures that the testing accurately assesses the eye’s natural state and refractive error without the influence of the eye’s automatic focusing adjustments.

Adult strabismus, or crossed eyes, often originates in childhood but can also develop in later life due to several factors

• Impairment of Visual Acuity in One Eye: When one eye has significantly reduced vision, it may lead to strabismus as the stronger eye dominates the visual field.
• Health Issues: Conditions like diabetes and thyroid eye disease, along with neurological disorders such as Myasthenia gravis, can affect eye muscle control. Additionally, serious conditions like brain tumors or experiencing a stroke can lead to the development of strabismus.
• Accidents or Head Injury: Trauma to the head can disrupt the alignment and functioning of the eye muscles, leading to strabismus.
• Damage from Eye Surgery: Surgical procedures on or near the eyes can sometimes inadvertently affect the eye muscles, resulting in misalignment.

These causes highlight the complexity of strabismus and the importance of addressing underlying health issues or injuries to manage or correct the condition in adults.

Treatment for strabismus encompasses a range of options designed to improve eye alignment and coordination, potentially yielding excellent outcomes, especially with early detection and intervention

• Eyeglasses or Contact Lenses: For some individuals, corrective lenses can help realign the eyes by adjusting the focus, particularly if the strabismus is caused by an underlying issue like farsightedness.
• Prism Lenses: These special lenses can modify the light entering the eye, aiding in the proper alignment of the eyes and improving binocular vision.
• Vision Therapy: A series of visual exercises and activities can strengthen the eye muscles, enhance coordination, and support the eyes in working together effectively. This non-surgical approach can be particularly beneficial for certain types of strabismus.
• Eye Muscle Surgery: For more pronounced cases or when other treatments are insufficient, surgery might be necessary to alter the length or position of the muscles around the eyes, making them appear straight. It’s common for surgery to be followed by vision therapy to fine-tune eye coordination and prevent the eyes from misaligning again.
  

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What Happens If Strabismus Is Not Treated?

• Risk of amblyopia (lazy eye)
• Reduced depth perception
• Cosmetic concerns and psychological impact
• Persistent double vision in adults

Early diagnosis leads to the best outcomes.

Frequently Asked Questions (FAQ)

Can strabismus go away on its own?

Usually no—professional treatment is needed.

Can adults be treated for strabismus?

Yes. Both surgical and non-surgical options are available.

Is strabismus surgery permanent?

Most patients achieve long-term improvement, but some may need additional treatment.

When should children be examined?

As early as possible. Eye alignment problems can be detected even in infancy.

Each treatment option is tailored to the individual’s specific condition and needs, with the goal of not only improving the appearance of the eyes but also enhancing visual function.