Strabismus in Children

Key Takeaway

Strabismus in children is a condition in which both eyes do not look in the same direction. The misalignment prevents the eyes from working together properly and can lead to amblyopia (lazy eye) if left untreated. The condition can be classified based on the direction of eye deviation—esotropia (inward turning), exotropia (outward turning), hypertropia (upward deviation), and hypotropia (downward deviation).
Treatment aims to realign the eyes and prevent amblyopia through vision correction, eyeglasses, eye exercises, amblyopia therapy, surgery, and regular follow-ups depending on the cause and severity.

Understanding Strabismus in Children

Strabismus in children is not uncommon and should not be ignored. If untreated, it can affect both vision and visual development in the long term. However, early detection and proper management can restore normal vision and eye alignment.
This article explores the causes, symptoms, diagnosis, and treatment options for pediatric strabismus, along with expert care guidelines from ophthalmologists at Vibhavadi Hospital, to help your child achieve clear vision and healthy visual development.

What Is Strabismus in Children? Can It Go Away on Its Own?

Strabismus occurs when both eyes fail to align and look at the same point simultaneously. This may become more noticeable when a child focuses on an object or becomes tired. In some cases, only one eye turns, or the deviation alternates between eyes.
The condition can result from problems in the eye muscles or abnormalities in the nerves that control eye movement.
Importantly, strabismus does not resolve on its own. Without appropriate diagnosis and treatment, a child may develop amblyopia, or lazy eye, in which one eye’s vision becomes weaker because the brain favors the other eye.

Types of Strabismus

Strabismus can be categorized according to the direction of deviation:

1. Esotropia – the eye turns inward; commonly seen in young children and may affect binocular vision.

2. Exotropia – the eye turns outward; often noticeable when the child is tired or focusing on distant objects.

3. Hypertropia – the eye deviates upward above the normal line of sight.

4. Hypotropia – the eye deviates downward below the normal line of sight.

There are also two less severe forms:

• Pseudostrabismus – the eyes appear misaligned due to facial structure, such as a broad nasal bridge or narrow eye folds, though the eyes are actually properly aligned.

• Phoria (latent strabismus) – a mild form in which the eyes tend to drift when one eye is covered but remain aligned when both are open.
  These conditions are generally less serious but should still be evaluated to rule out true strabismus.

Common Causes of Strabismus in Children

Several factors can cause eye misalignment:

• Genetic factors – a family history of strabismus increases the likelihood of developing the condition.

• Weak or imbalanced eye muscles – when the muscles controlling eye movement do not coordinate properly.

• Refractive errors – nearsightedness, farsightedness, or astigmatism may cause one eye to turn as it attempts to focus.

• Neurological or systemic conditions – issues in the brain that control eye movement or certain diseases can contribute.

• Eye injury or disease – trauma or other eye disorders can also lead to misalignment.

How to Recognize Strabismus in Children

Parents should observe the following signs:

• Eyes that do not look in the same direction.

• Blurred or double vision.

• Tilting the head or closing one eye to see clearly.

• Frequent blinking, squinting, or eye rubbing.

• Difficulty focusing on near or distant objects with both eyes.

Warning Signs That Require a Doctor’s Visit

If any of the following symptoms appear, a visit to a pediatric ophthalmologist is strongly advised:

• Noticeable eye deviation, even when the child looks straight ahead.

• Double or blurry vision.

• Frequent head tilting or squinting to focus.

• Eye irritation or discomfort suggesting visual strain.

• Preference for using one eye over the other.

Early diagnosis is key—prompt evaluation and treatment help prevent lazy eye and ensure proper visual development.

Diagnosis of Strabismus in Children

Diagnosis involves several steps:

1. Preliminary Examination

• Visual observation: The doctor watches the child’s eye movements and alignment.

• Light reflex test: A small light is shone into the eyes to check if reflections are symmetrical.

• Vision testing: Assesses clarity of sight and coordination between both eyes.

2. Detailed Evaluation
If misalignment is detected, further tests are performed:

• Refraction test: Determines if refractive errors contribute to the condition.

• Eye muscle assessment: Evaluates the strength and coordination of eye muscles.

• Imaging or specialized tests: May include ocular photography or advanced diagnostic tools to assess eye structure and nerve function.

Treatment Options for Strabismus in Children

The goal of treatment is to realign the eyes, strengthen coordination, and prevent amblyopia. The method depends on the cause and severity.

1. Correcting Refractive Errors

Eyeglasses can correct nearsightedness, farsightedness, or astigmatism—reducing the need for the eyes to overcompensate and thus improving alignment. In many cases, consistent use of glasses can significantly reduce or eliminate the strabismus.

2. Treating Amblyopia (Lazy Eye)

When one eye has reduced vision, the doctor may recommend patching therapy, where the stronger eye is covered for a few hours daily to encourage the weaker eye to work harder. This helps retrain the brain to use both eyes together effectively.

3. Strabismus Surgery

If misalignment is caused by muscle imbalance that cannot be corrected with glasses or exercises, surgery may be required. The procedure involves adjusting the muscles that move the eyes to restore proper alignment. Surgery helps improve binocular vision and cosmetic appearance while preventing amblyopia.

4. Vision Therapy and Rehabilitation

Post-treatment rehabilitation often includes vision therapy—activities or exercises designed to strengthen coordination between the two eyes. These may include games or tasks that require binocular focus, helping the child’s eyes work together naturally and reducing the chance of recurrence.

5. Regular Follow-Up

Long-term follow-up appointments are crucial to monitor progress, check for muscle balance, and detect any recurrence. Continuous care ensures that the child’s visual system develops normally and that treatment remains effective.

Prevention and Home Care for Strabismus and Lazy Eye

Parents can help prevent or manage strabismus by:

• Scheduling early eye screenings – have your child’s vision checked regularly from infancy.

• Observing behavior – look for signs such as crossed eyes, frequent squinting, or head tilting.

• Correcting vision problems early – follow medical advice regarding eyeglasses or vision correction.

• Encouraging visual development – use toys or games that promote focusing and coordination.

• Protecting the eyes from injury – avoid sharp or hazardous objects during play.

• Following medical advice consistently – use prescribed glasses or perform eye exercises as directed by the doctor.

Pediatric Strabismus Treatment at Vibhavadi Hospital

At Vibhavadi Hospital’s Eye Center, pediatric strabismus care begins with a detailed evaluation by experienced ophthalmologists. Each treatment plan is customized to the child’s specific condition.
For cases involving refractive errors, corrective lenses are prescribed to improve focus and coordination. If amblyopia is present, patching or visual training may be recommended. For muscle imbalance, eye muscle surgery may be necessary to align the eyes.
The hospital also offers post-treatment visual training programs and continuous follow-up to ensure long-term success. With advanced technology and specialized pediatric eye care, Vibhavadi Hospital provides comprehensive management to help children achieve normal vision and optimal eye development.