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  • Writer's pictureAtanas Bogoev M.D. and Maria Cholakova

Strabismus in Children

Strabismus in children occurs when the eyes of the child are not aligned properly, causing one or both eyes to turn inward, outward, upward, or downward. Throughout this guide, we hope to provide parents with a better understanding of the eye condition. We focus on its causes, prevention, treatment options, and potential impact of strabismus on vision.


Having a Child with Strabismus: What to Expect?


Parents of children with strabismus may experience a range of emotions, including confusion, worry, and frustration. Not to mention the 'what ifs'.


Looking for answers to the endless questions that arise is only natural. But not everything you read on the internet is correct or medically fact-checked (unlike this article). Our advice is to seek guidance from strabismus specialists who can provide accurate diagnosis, treatment, and ongoing support. And don't forget, a child with strabismus will need the parents' assurance and a safe and supportive environment.


What is Strabismus in Children?


Strabismus refers to the misalignment of the eyes and a lack of coordination between the eye muscles. The manifestations of the conditions are:


  • Esotropia (inward deviation)

  • Exotropia (outward deviation)

  • Hypertropia (upward deviation)

  • Hypotropia (downward deviation)


Strabismus can occur in newborns, infants, toddlers, and older children.


strabismus inforgraphic

Why Does Strabismus Occur?


The exact cause of strabismus in children is not always clear.


It is often the result of abnormalities in the muscles controlling eye movement or issues with the nerves that transmit signals to these muscles.


Some children may inherit a predisposition to strabismus. Others may develop it due to factors such as refractive errors, eye muscle imbalance, premature birth, or neurological conditions.


How Does Strabismus Affect Vision?


Strabismus can affect vision in several ways.


When the eyes misalign, the brain may suppress the image from one eye to avoid double vision, leading to amblyopia (lazy eye) in the affected eye. Without treatment, amblyopia can result in permanent vision loss.


Moreover, strabismus can cause diplopia (double vision) and nystagmus (involuntary eye movements). These eye problems further impair visual function and could have long-term effects.


Can You Prevent Strabismus in Children?


While it may not be possible to prevent strabismus every time, early detection and intervention potentially minimize its impact. Regular eye exams by a pediatric ophthalmologist are the best way to identify signs of strabismus and other vision problems in infants and young children.


Will Strabismus Cause Blindness?


Strabismus itself does not typically cause blindness. However, untreated strabismus may lead to lazy eye and a decrease of vision in the affected eye. A prompt diagnosis and intervention can prevent this type of vision impairment. With adequate and on-time treatment, children with strabismus tend to improve their visual function and quality of life.


When Do Children Develop Strabismus?


While it can manifest at any young age, strabismus often becomes noticeable during infancy or early childhood.


In newborns, strabismus isn't always obvious, but careful observation by parents or doctors may detect signs of abnormal eye alignment. Newborns may exhibit intermittent eye misalignment, however, there's a difference between normal variations in eye appearance during infancy and true strabismus. Persistent misalignment or an inability to focus both eyes on the same object could indicate crossed eyes.

The diagnosis of a newborn prompts an evaluation by a pediatrician or an eye care specialist.
baby with strabismus

As babies and toddlers grow and develop, strabismus can become more apparent. That's the time when little ones start tracking objects or making eye contact. During periods of such high visual attention and eye coordination tasks, it gets easier to spot warning signs. Along with the irregular eye position, strabismus baby parents may observe head tilting or squinting. These behaviors compensate for the misalignment.


In children, the signs that something is going on with their eyes are most noticeable. It's easier to spot a child with eye misalignment, compared to a baby. So parents have to take appropriate steps toward correction. After all, untreated strabismus may lead to lazy eye or other ocular conditions.


What Are the Warning Signs?


The main indication of strabismus in children is one or both eyes may appear to be turned inward or outward. The secondary symptoms are squinting or closing one eye, poor depth perception, and frequent eye rubbing. Some children may tilt their heads to one side or tilt their chin up or down to adjust their vision. Rapid and uncontrollable eye movements may accompany strabismus in some cases.



Strabismus Associated Eye Conditions


Strabismus in children often (not always) presents alongside other vision disorders. Understanding these conditions and their connection is crucial for effective management and treatment.


Strabismus with Amblyopia


Amblyopia (lazy eye) occurs when the brain favors one eye over the other. As a result, the weaker eye loses visual acuity. In cases of strabismus, the brain may suppress the misaligned eye to avoid double vision. The suppression could happen gradually so the child might not even notice the changes right away.


What can save your child's vision, though, is an early amblyopia diagnosis!

A reminder not to skip routine eye exams. Correction of strabismus with amblyopia may involve patching the stronger eye to encourage visual development in the weaker eye. Along with the patch, corrective lenses can further improve treatment outcomes.


Strabismus with Diplopia


Diplopia, or double vision, is a common symptom of strabismus, especially when the misalignment of the eyes is significant. When the eyes misalign, each eye may send a separate image to the brain. Thus resulting in constant overlapping or duplicated images.


The discomfort and confusion are severe in the cases of strabismus with diplopia. Young children, in particular, may struggle to articulate their visual experiences. Management of the conditions tends to involve corrective lenses, prisms to align images, and, in some cases, strabismus surgery to realign the eyes and restore single binocular vision.


Strabismus with Nystagmus


Nystagmus refers to rhythmic, involuntary movements of the eyes. They occur spontaneously or in response to visual stimuli. While not always present in cases of strabismus, nystagmus may accompany it, more so in certain neurological conditions.


Nystagmus can further disrupt visual function and coordination, complicating strabismus treatment. Lenses, visual aids, and medication to dampen eye movements are the popular correction options. Certain cases may require strabismus surgery to improve eye alignment and reduce nystagmus severity.


crossed eyes child

Strabismus Correction & Treatment


Most parents want to know can strabismus be corrected and how early is it recommended and safe to treat their child's eye misalignment. Let's answer these questions!


The common treatment options for strabismus in children are:

  • Eyeglasses

  • Eye patches

  • Surgery

  • Combination therapy


The choice of correction method depends on the severity and underlying cause of strabismus.


Eyeglasses


The first line of treatment for children with strabismus is eyeglasses. If the child has refractive errors like nearsightedness, farsightedness, or astigmatism, they may further contribute to eye misalignment. Corrective lenses provide clear vision, reduce eye strain, and promote better alignment of the eyes.


Eye Patches


Eye patching is a go-to therapy for treating amblyopia which often coexists with strabismus. By covering the stronger eye with a patch, it encourages the brain to rely more on the weaker eye. With time, this intervention improves visual acuity and encourages the natural development of vision of the weaker eye.


child with lazy eye

Strabismus Surgery


Children with persistent eye misalignment who don't respond to other treatments may need strabismus surgery. The goal is a realignment of the eyes to improve binocular vision. Candidates for strabismus surgery undergo an in-depth evaluation to assess the degree of the eye misalignment before the procedure. Ophthalmic surgeons perform surgery (usually under general anesthesia) during which the corresponding eye muscles are adjusted in length or position according to the eye globe.


Combination Therapy


A combination of non-surgical and surgical treatments may lead to optimal outcomes. If strabismus is severe or occurs along with refractive problems such a broad approach tends to improve visual function and alignment most effectively.


Final Thoughts...


Regular monitoring by a pediatric eye doctor is key to assessing progress and ensuring proper alignment of the eyes as the child grows. With timely intervention and ongoing support, many children with strabismus can improve their eye alignment and visual function.


Here are a few helpful resources you may want to take a look at:



Read more of our articles for children's eye health in the suggested posts section down below.


Checked by Atanas Bogoev, MD.

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