Strabismus in Children: Understanding Crossed Eyes and Recommended Treatment Options

Strabismus, or crossed eyes, is one of the most common paediatric eye problems today.

A study conducted in Ethiopia showed that 17.9% of the children who participated have paediatric strabismus.

Results from a study conducted in Hong Kong showed that 3.11% of the school-aged participants have strabismus, a number significantly higher than those obtained from other Asian countries.

But what is strabismus? A trusted eye doctor in Dubai explains that this condition is characterised by the misalignment of one or both eyes.

It usually develops in children with poor eye muscle control, which is often caused by a neuromuscular condition or severe hyperopia (farsightedness).

Research also shows that children are more likely to develop this strabismus when one or both of their parents have this condition.

This eye problem typically develops in infants and early childhood, usually appearing before a child reaches the age of three.

However, older children and adults can develop this condition as well.


Types of Strabismus

Strabismus is usually classified by the direction the eye turns. These types are:

  • Esotropia – Also called convergent strabismus, this condition is characterised by the deviating eye turning in towards the nose.
  • Exotropia – Also known as divergent strabismus, it refers to the condition where the deviating eye turns outwards.
  • Hypertropia – A type of vertical strabismus where one eye is higher than the other.
  • Hypotropia – A type of vertical strabismus where one eye is lower (hypotropia) than the other.

Strabismus can also be constant or intermittent, which is based on the frequency at which it occurs.

Additionally, this condition can either be unilateral, meaning it’s always the same eye deviating, or alternating, when the misalignment sometimes happens in the right eye and left eye at other times.

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Common Symptoms

The most common signs of strabismus in children are the following:

  • Eyes that do not look in the same direction or move together simultaneously.
  • Squinting or closing one eye when exposed to bright sunlight.
  • Turning or tilting their head to look at something.
  • Bumping into objects accidentally frequently.

Newborn babies usually have misaligned eyes during their first few months. However, their eyes become aligned when they reach three to four months.

In some instances, an infant’s eyes may appear misaligned because they have a wide nasal bridge. This condition is called pseudostrabismus.

However, if the baby’s eyes are misaligned all the time when they turn four months old, they need to undergo an eye exam at a specialist’s clinic.

Aside from the mentioned symptoms, older children with strabismus also complain about blurred and double vision, tired eyes and sensitivity to light. These signs usually come and go and get worse when they are exhausted or sick.

Diagnosing Strabismus

If your child is showing signs of strabismus and is at least four months old, bring them to an ophthalmologist for a consultation.

During the initial consultation, the specialist will ask about your child’s symptoms, any health problems they may have and medications they are taking. You will be asked if anyone in your family has been diagnosed with strabismus.

Once the ophthalmologist has the details they need, they will diagnose this condition by looking at your child’s eyes. They will also conduct some tests to confirm their diagnosis.

These tests can include visual acuity, alignment and focus, and refraction.

Ophthalmologists usually conduct refraction tests on infants and young children who cannot speak or have limited communication skills to check the alignment of their eyes.  By comparing the position of the light reflecting off each eye, they can diagnose if the child has strabismus.

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Children who can communicate are given the alternating cover or cover-uncover test to check if they have intermittent and constant strabismus.

Treatment Options

Treatment for strabismus in children will depend on the severity of the condition.

Treatment options for mild strabismus in children include the following:

  1. Prescription eyeglasses

Your child has to wear eyeglasses that will fix the vision in the weaker eye or blur vision in their healthy eye to fix their strabismus.

2.Eye patch

The ophthalmologist can recommend an eye patch to cover your child’s non-wandering eye, forcing them to use the weaker one to see. This treatment can strengthen your little one’s weak eye muscles and correct their vision.

3. Eye drops

If your child doesn’t like wearing an eye patch, the specialist will recommend eye drops to blur their good eye to encourage them to use the weaker one.

Children with severe strabismus may have to undergo surgery to correct their crossed eyes.

This treatment is usually recommended for young children diagnosed with constant strabismus.

While your child is under general anaesthesia, the specialist will make a small cut in the tissue covering the eye. They will loosen the eye muscles to make them pull less or tighten them to make them pull harder. This procedure will correct their strabismus.

Your child may need to wear an eye patch or receive eye drops, or both, after the surgery.

Most patients can get back to their daily routine within two to three days after their surgery.

Understanding the symptoms and causes of paediatric strabismus is the first step towards effective treatment.

While the treatment approach may vary from one child to another, early intervention and consultation with an eye care specialist are essential for the best outcomes and help them prepare for their physical, intellectual, emotional, social and academic growth.