Strabismus: Definition, Types, Symptoms, Causes, Risk Factors, Treatment and Precautions

A simple definition of strabismus-strabismus is a misalignment of the eyes.

It is commonly called “crossed eyes” and affects five to 15 million people in the United States alone.

It includes misalignment, such as one eye pointing in, out, up, or down rather than in the same direction as the other eye.

Fortunately, many cases of strabismus can be improved with treatment. The goal of therapy is to help minimize vision problems. By getting treatment for strabismus and taking steps to care for your vision, you can help resolve or improve the condition.

What is strabismus?

Strabismus is a condition that causes the eyes to look in different directions. It happens when the muscles that control one of the eyes do not keep it aligned correctly with the other. This can result in double vision. Strabismus can coexist with other eye problems, such as:

  • Problems moving the eyes ideally.
  • Not being able to see well.
  • Have eye pain or discomfort.
  • Headaches.
  • Hold your head at odd angles.

Cross-eyed doesn’t go away on its own. If left untreated, strabismus can worsen and cause lazy eyes, permanent vision loss, blurred vision, eye strain, poor depth perception, low self-esteem, tiredness, and headaches.

These problems can, in turn, lead to other issues, such as injury, blindness, poor quality of life, poor academic or work performance, low productivity, and limited social interaction.


Many people with this condition have crossed eyes, but in some people, it comes and goes (known as “intermittent” strabismus). It can occur at any age, but most cases affect children and begin before six years old.

Types of strabismus

There are many ways to categorize this condition. These include:

The direction of the misaligned eye:

  • Eyes inward (stripe).
  • Eyes out (exotropia).
  • Looking up (hypertropia).
  • Downward gaze (hypotropia).

When the problem starts:

  • Childhood.
  • Early childhood (usually 2 or 3 years of age).
  • Adolescence.
  • Adulthood.

Which eye is affected:

  • The same vision is constantly involved.
  • The same eye is affected; yes, sometimes no.
  • The problem changes between the eyes.

How bad is the misalignment:

  • Light.
  • Moderate.
  • Grave.

Possible cause of the problem:

  • Inherited (runs in the family).
  • Poor vision
  • Injury.
  • Stroke.
  • Tumor.
  • Infection or other issues with the eye.
  • Unknown cause.

The type of strabismus you have can dictate the kind of treatment you need.

Is lazy eye the same as strabismus?

Strabismus vs. Amblyopia: What’s the Difference? Strabismus is being crossed, while amblyopia is a condition known as lazy eye. The two conditions may appear the same to an observer, as amblyopia can also cause one gaze to drift inward or outward.

Strabismus is the most common cause of lazy eyes. However, lazy eye is due to the vision of one eye not fully developing, and it can occur even without being crossed.

When the weak muscles that cause strabismus keep one eye pointing in the wrong direction, the brain stops tracking the mismatched eye input. Vision becomes poor in that soft and “lazy” eye.

Alternatively, something can cause poor vision at first, and eventually, the brain ignores the images coming from that eye.

Fortunately, both lazy and crossed eyes can usually be treated effectively, especially if caught early. But as is the case with all functional vision problems, they can be treated at any age.

Can strabismus be prevented?

Most cases of strabismus in children have no known cause. Additionally, many of the known causes of strabismus cannot be prevented, such as congenital disabilities, genetic conditions, strokes, and other health problems.

While people can do whatever they can to protect themselves from these possible causes, they may or may not help prevent strabismus. However, regular eye exams can help identify the risk of squinting early before it results in complete strabismus.

Some cases seem to run in families. While these cases cannot be prevented, anyone with a family member with crossed eyes should receive an early and regular vision evaluation.

The muscle weakness that often leads to strabismus in very young children can be detected and corrected before it results in complete misalignment.

In general, while it cannot be prevented, complications of strabismus can be avoided if the condition is caught early and treated appropriately.

Can strabismus be treated?

In most cases, strabismus can be treated effectively. The goal of treatment is to preserve or restore vision. Whether it can be corrected entirely, restoring both the appearance of the eyes and their vision, depends on its cause and how long it was not treated.

Most people with strabismus treated early (before age 6) have an excellent prognosis. Strabismus in adults can also be treated effectively.

However, there are cases where the alignment of the eye after treatment is not perfect or returns to misalignment over time. Some people also do not regain full vision even with treatment.

Signs and symptoms of strabismus

In children with strabismus, symptoms usually appear before the age of 3 but most often by 6. However, older children and adults can also develop crossed eyes.

Signs and symptoms of strabismus include:

One eye pointing in the wrong direction (turned inward or up or down). One look moves or shifts while the other eye is in focus. I am squinting one eye—frequent blinking, especially in bright sunlight.

Rub one or both eyes constantly. Tilt or move your head to see something better: double vision and split vision (seeing a regular image plus a half or partial).

View shaky or moving images. Eye fatigue or tension. Headache. Bad depth perception. Constant or occasional trouble focusing, especially when you are tired or ill.

Eye doctors can also see signs of strabismus in the eye muscles and movement during an exam.

Causes and risk factors

The causes of strabismus and risk factors vary by age. There is no known cause in most cases, and the condition occurs early in life. However, strabismus causes and risk factors include:

  • Family history of crossed eyes.
  • Stroke.
  • Poor vision (farsightedness) or loss of sight.
  • Head or brain trauma.
  • Eye wound.
  • Cerebral palsy.
  • Down syndrome.
  • Hydrocephalus (a buildup of fluid in the head that occurs in some newborns).
  • Brain tumor or nervous system problem.
  • Graves’ disease.
  • Apert syndrome.
  • Rubella in newborns.
  • Hemangioma near the eye in babies.
  • Incontinentia pigment syndrome.
  • Noonan syndrome.
  • Prader-Willi syndrome.
  • Eye problems in the newborn such as retinopathy or retinoblastoma.
  • Trisomy 18.
  • Botulism.
  • Diabetes.
  • Síndorme of Guillain-Barré.
  • Shellfish poisoning.

Conventional treatment

Begin treatment as soon as you can. If you don’t, the condition could continue into adulthood. Most cross-eyed adults were born that way.

Talk to a pediatric ophthalmologist, an ophthalmologist specializing in working with children.

People who have other eye problems, such as lazy eyes or cataracts, usually receive treatment for those conditions before starting strabismus treatment.

Conventional treatments for people with crossed eyes generally depend on the type of alignment problem. In some cases, treating an underlying condition (such as a brain tumor) can resolve strabismus without specifically treating the alignment problem.

You can expect at least one of the following crossed eye treatment recommendations:

  • Eyeglasses.
  • Eye exercises.
  • Prisms (thick prismatic glasses to reduce how much the eye must rotate).
  • You can start treatment with a patch to force your child to wear the deviated eye until they usually see.

So is using drops to blur the vision of the strong eye (this forces the weaker eye to try to align and focus). The main goal is to make the problem look work as it should before your child is eight years old. After that, permanent vision loss can set in.

Is surgery an option?

Vision correction is the first step in almost all strabismus treatment plans. Then, if the eyes don’t move together after glasses or a patch improves vision, surgery may be necessary.

It works best when done during childhood, but adults can have it too. Most people recover from surgery within a few days.

The surgeon opens the outer layer of the eyeball to reach a muscle. To strengthen the power, the surgeon removes a small section from one end, putting it back in the same place. This makes the muscle shorter, which causes the eye to turn to that side.

The doctor moves it back or makes a partial cut through it to weaken a muscle. The eye moves away from that side. After surgery, any double vision should go away within a few weeks as the brain adjusts to the improved image.

However, many people may need glasses permanently, and some people may need more than one operation. Strabismus is not treated early and can lead to permanent vision loss.

Natural ways to improve the symptoms of strabismus

In the case of strabismus, many treatments recommended by ophthalmologists can be considered natural.

Most conventional treatments for people with crossed eyes do not require medication. Two natural ways to improve symptoms, in addition to glasses, include:

  • Strabismus exercises.
  • A formal vision therapy program (orthoptics).

Please note that you should not attempt to create your strabismus treatment plan without consulting an eye doctor.

This is because strabismus can coexist with other eye problems, or it can be another eye problem that looks like a crossover in the eyes. Professional diagnosis and treatment are essential.

Strabismus exercises

These exercises are exactly what they sound like: a workout for your eye muscles. While eye exercises alone are not enough to correct crossed eyes in most cases, they are often an essential part of a treatment plan.

These exercises can be done two to 10 times per day and should only take a few minutes to complete. Activities for crossed eyes include:

Pencil Push-Ups:

  1. Hold a pencil at arm’s length, pointing the tip away from your eyes.
  2. Focus on the draft.
  3. Slowly bring the eraser up to the bridge of your nose.

Follow it with your eyes until you can no longer see it. Move the pencil back to arm’s length and repeat several times.

Trombone Exercise: Like the push-ups with pencils, this exercise consists of holding a small object with the arm extended. However, it would help if you cover your good eye.

Keep the object where your weak eye points typically. Keep your head pointed forward. Focus on the thing with your soft eye and move the object until your vision looks directly in front of you. Try to keep the subject in focus. Repeat this up to 20 times, varying the speed and distance of the object.

Rope Exercise: Slide three different colored beads at equal intervals on a rope about 5 feet long. Tie one end of the string to something that won’t budge, such as a table, railing, or cabinet knob.

Hold the other end firmly against your nose, so the string is taut. Focus on the account closest to you. It should appear only at the cross of an X made up of identical doubles of the line in front of and behind the bead.

If you see a crossed thread in front of or behind the bead, your eyes will not focus properly on the dot. Once you know the account in the X center, shift your focus to the central budget. It should look the same: a single bead in the center of an X made from the images of the rope.

Once the center bead is in focus, shift your gaze to the farthest bead. It should be at the point of an inverted V, where the two lines of the V are the identical string images coming your way. Once you can properly focus on all three beads, move them around the string and do the exercise again.

Barrel Cards – Draw three barrels in a row in red ink on a letter. One should be large, the middle one should be medium, and the other should be small. Flip the card over. Draw matching barrels on the opposite side in green ink.

Hold the card against your nose with the enormous barrels furthest from your eyes (directly from your face) and the miniature barrels closest to your nose.

Please focus on the far-away barrels until they blend into one image. The other barrels should still appear double. Hold your focus for about five seconds. Repeat the exercise with the medium and small barrels.

Rotating Mirror – Stand with your back to a mirror, feet far enough apart to don’t lose your balance when you turn. Cover your good eye and look ahead with your weak eyesight.

Turn your upper body to the side of your weak eye (for example, if your left eye is soft, turn to the left to look back). Move your watery eye until you can see your eye in the mirror. Then return to the starting position.

Repeat this process up to six times, then cover your weak eye and repeat the exercise with your strong eye.

Side Bends: Stand with your feet shoulder-width apart. Raise your hands out on each side at shoulder height.

Turn your head and weak eye to look at the hand in the opposite direction of your soft eye (for example, if it is pointing to the left, look to the right hand).

Bend your upper body to the other side so that the hand you are looking at goes toward the ceiling and the other hand toward the floor. Slowly return to the starting position. Repeat the exercise by looking at the other hand and tilting the other direction.

Vision therapy (orthoptic)

Vision therapy programs are developed by an ophthalmologist and are often practiced both in the doctor’s office and at home. They usually combine a series of doctor-performed eye exams with weekly or monthly eye exercise routines.

The doctor will have the patient practice the exercises in the office to make sure they are doing them correctly and will then check the progress in eye alignment at each visit. These programs are often used for people with occasional strabismus.

The doctor prescribes exercises that target a particular alignment problem in professional vision therapy programs. Some eye treatment centers offer digital programs that have eye exercises or games for children or adults to do while looking at a computer screen.

Over time, the specific exercises your doctor recommends may change based on your symptoms. The therapy program can improve the muscles of the weak eye, so regular observation and testing by your eye doctor will help you know sooner if your efforts are practical.


Do not try to diagnose strabismus without the help of an eye doctor. It can be confused with other neurological conditions or disorders. In some cases, the eye control problem can also signify a serious underlying health problem, such as a brain tumor.

A professional must evaluate crossed eyes, double vision, or other problems that control or focus the eyes.

Don’t avoid conventional treatment hoping that crossed eyes will go away on their own. In addition to the cases in babies that sometimes disappear within a few months, strabismus requires treatment.

Although not everyone will need glasses or surgery, most people require more than vision therapy and eye exercises to regain normal eye alignment. The eye exercises in this article are not a substitute for specific exercise advice and care from an ophthalmologist.

If strabismus is not treated correctly at an early stage, it can lead to permanent vision loss or vision problems.

Key points of strabismus

Strabismus includes any ocular misalignment. It is commonly called “crossed eyes,” but the weak eye can point in any direction: in, out, up, or down. Misalignment is caused by weak eye muscles that cannot control where the soft eye looks.

The condition is most common in young children, although it can occur. In most cases, the cause of strabismus is unknown. However, causes include congenital disabilities, strokes, brain injuries, diabetes, and other diseases.

Conventional treatment generally includes glasses and surgery. Underlying vision problems, such as cataracts or farsightedness, can be treated before proceeding with specific therapy for strabismus.

Strabismus should not be left untreated, as it can lead to permanent vision damage. When treated early, this vision problem can usually be corrected to align the eyes.

Natural therapies to help improve the symptoms of strabismus include:

  • Eye exercises for strabismus.
  • Formal vision therapy programs.