Strabismus in Children

Strabismus is an eye condition that means your child’s eyes do not work together or do not always look in the same direction at the same time (misalignment).

One of your child’s eyes may be straight while the other eye turns inward, outward, upward, or downward.

In some children, the same eye always turns (unilateral strabismus). For others, each eye may turn at different times (alternating strabismus). The misalignment may be constant or it may come and go.

Strabismus results from a problem with the connection between the brain and the eye. Strabismus makes the brain unable to process the two different images that each eye sends to the brain. This can lead to poor vision or vision loss (amblyopia).

It is important to detect strabismus early. The sooner treatment begins, the more likely it is that vision loss can be prevented and that your child’s eyes can work together.

What are the causes?

This condition can be caused by any problem with:

• Eye muscles.
• Nerves that send signals to the muscles.
• The area of the brain that controls eye movement.

What increases the risk?

Your child may have a greater risk of strabismus if he or she:

• Is younger than 3 years old.
• Has a brain condition, such as:
  • Cerebral palsy.
  • Down syndrome.
  • Hydrocephalus.
  • Tumor.
  • Stroke.
• Is farsighted (has hyperopia).
• Was born prematurely.
• Has a family history of strabismus.

What are the signs or symptoms?

The main sign of strabismus is eyes that do not look in the same direction. Children with strabismus may also:

• Have double vision.
• Get headaches.
• Squint frequently with one eye.
• Tilt their head when looking at a distance.
• Cover one eye while reading or doing close work.

How is this diagnosed?

This condition is diagnosed based on your child’s symptoms, medical history, and a physical exam. Your child may need to see a health care provider who specializes in eye conditions (ophthalmologist) for an eye exam to confirm the diagnosis and to rule out other conditions. Your child may have tests to:

• Evaluate how well your child can see (visual acuity test).
• Determine whether your child needs lenses to correct nearsightedness, farsightedness, or astigmatism (refraction).
• Check how well your child’s eyes focus and move together (alignment and focusing test).

How is this treated?

Treatment for this condition may include:

• Wearing corrective lenses to align the eyes.
• Strengthening the weaker eye. This may be done by wearing a patch over the stronger eye for a period of time each day. Eye drops that blur the stronger eye may also be used.
• Eye exercises (vision therapy) to strengthen the connection between the brain and the eye.

Surgery may be necessary if eyeglasses are not enough to prevent the eye from turning. Your child may have a procedure to change the length or position of the muscles around the eye. This can help the eyes stay straight and work together.

Follow these instructions at home:

• Follow instructions from your child’s health care provider about how and when your child should:
  • Wear glasses.
  • Wear an eye patch or use blurring eye drops.
  • Do eye exercises.
• Keep all follow-up visits as told by your child’s health care provider. This is important.

Contact a health care provider if:

• Your child’s eye continues to turn, even while wearing glasses.
• Your child’s eye turning gets worse.

Get help right away if:

• Your child loses vision.
• Your child has a white reflection in his or her pupil.