Crossed eyes (Squint, Strabismus)

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Strabismus (crossed eyes)

Strabismus, also known as crossed eyes, is characterized by a misalignment where each eye points in a different direction. This condition may be caused by an imbalance in the muscles responsible for positioning the eyes or by uncorrected refractive errors like hyperopia.

Six muscles control the eye’s movement, receiving signals from the brain. Proper coordination ensures both eyes focus on the same point. Control issues can lead to misalignment, causing the eyes to turn in, out, up, or down. This misalignment can be constant or appear when fatigued or reading. Maintaining proper alignment is crucial to prevent double vision and poor vision development.

If untreated, persistent misalignment may lead to amblyopia or lazy eye. Newborns may appear to have misaligned eyes due to pseudostrabismus, often resolving as they grow. Strabismus commonly emerges between infancy and the ages of 2 to 3 years but can also impact older children and adults.

Contrary to belief, it may not resolve on its own, necessitating examination by an eyecare professional, especially if the misalignment persists beyond 4 months of age.

Strabismus Is Classified By The Direction in The Eye Turns:

  • Esotropia: inward turning
  • Exotropia: outward turning
  • Hypertropia: upward turning
  • Hypotropia: downward turning

Other Classifications Of Strabismus Include:

  • The frequency with which it occurs (either constant or intermittent).
  • Whether it always involves the same eye (unilateral).
  • If the turning eye is sometimes the right eye and other times the left eye (alternating).

Accommodative Esotropia

Accommodative esotropia often results from uncorrected farsightedness (hyperopia), leading to one eye turning inward. Common symptoms include double vision, covering one eye during close work, tilting the head and eye strain at near.

Intermittent Exotropia

Intermittent exotropia occurs when both eyes struggle to coordinate, causing one eye to point outward. Symptoms include headaches, difficulty reading, eye strain, and the tendency to close one eye in bright light or when viewing at a distance.

Causes & Risk Factors

Strabismus, commonly known as crossed eyes, may stem from issues related to the eye muscles, nerves responsible for muscle communication, or the brain’s control center governing eye movements.

Additionally, it can be triggered by various general health conditions or injuries to the eyes.

Risk Factors For Developing Strabismus Include:

Family History: Individuals with a family history of strabismus, particularly those with affected parents or siblings, have a higher likelihood of developing this condition.

Refractive Error: Uncorrected farsightedness (hyperopia) plays a significant role in the development of strabismus. The constant effort required to focus on objects can contribute to the occurrence of this eye condition.

Medical Conditions: Certain medical conditions increase the risk of strabismus. Individuals with conditions such as Down Syndrome, cerebral palsy, or those who have experienced a stroke or head injury are particularly susceptible.

Symptoms

  1. Eyes that look misaligned.
  2. Eyes that do not move together.
  3. Frequent blinking or squinting, especially in bright sunlight.
  4. Tilting the head to look at things.
  5. Faulty depth perception
  6. Double vision

Treatment

Strabismus treatment options range from eyeglasses and prism lenses to vision therapy and eye muscle surgery. Early detection and intervention often lead to successful correction. Eyeglasses or contact lenses may suffice for some, while prism lenses reduce eye movement. 

Vision therapy involves structured activities to enhance coordination. Eye muscle surgery is capable of repositioning the eye muscles, and individuals with strabismus may undergo multiple surgeries throughout their lifetime if necessary.

Post-surgery, vision therapy may be recommended to maintain sensory fusion to train the brain on image to image correspondence to align and improve coordination. Early intervention and a tailored approach contribute to optimal strabismus management.