Strabismus (misaligned eyes) is a condition in which one eye is turned in a direction that’s different from the other eye. It’s usually found in children, but it can also happen in adults. Treatment may include glasses, patching, eye exercises, medication or surgery.
Strabismus (misaligned eyes) is a condition in which your eyes don’t line up with one another. In other words, one eye is turned in a direction that’s different from the other eye.
Under normal conditions, the six muscles that control eye movement work together and point both eyes in the same direction. If you have strabismus, these muscles have issues controlling eye movement and can’t keep normal ocular alignment (eye position).
While strabismus is mainly found in childhood, adults can also experience strabismus. Most commonly, strokes cause ocular misalignment in adults. Another cause is physical trauma. But you can be an adult with childhood strabismus that wasn’t treated or was treated and has come back (recurred) or gotten worse.
There are several forms of strabismus. The most common are:
Providers may also name strabismus based on which way your misaligned eye points, how often it happens, if it happens to one eye only or if it goes between your left and right eyes. Strabismus, then, can be described in these ways:
Providers might also classify strabismus based on the nerves that aren’t working correctly, like oculomotor palsy, superior oblique palsy or abducens palsy. (The causes of these particular strabismus types are the third, fourth and sixth cranial nerves.)
An estimated 4% of the U.S. population — or about 13 million people — have strabismus.
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Symptoms of strabismus include:
Strabismus usually appears in infants and young children, and most often by the time your child is 3 years old.
But it’s normal for your newborn to have misaligned or wandering eyes from time to time. By the age of 3 to 4 months, your baby’s eyes should be able to focus on small objects and they should be straight and well-aligned. A 6-month-old baby should be able to focus on objects both near and far.
The sudden appearance of strabismus — especially with double vision — in an older child or adult could indicate a more serious neurologic disorder. If you or your older child develop misaligned eyes or it happens suddenly, call a healthcare provider right away.
A condition called pseudostrabismus (false strabismus) makes it look like your baby has misaligned eyes when they really don’t. This can happen because your baby has extra skin that covers the inner corners of their eyes or their nasal bridge is flat. As your baby’s face develops and grows, their eyes won’t look misaligned anymore.
Most strabismus happens because of a problem with neuromuscular control of your eye movement, which involves your brain. Less commonly, there’s an issue with the actual eye muscle. Another factor is family history. About 30% of children with strabismus have a family member with a similar condition.
Other conditions that are risk factors for misaligned eyes include:
Some believe that children will outgrow misaligned eyes or that the condition will get better on its own. In truth, it can get worse if it isn’t treated.
If your eyes aren’t properly aligned, you may have:
It’s also possible a serious issue (like a brain tumor) may be overlooked if your healthcare provider doesn’t diagnose and follow your strabismus.
Any child older than 4 months who appears to have strabismus should have a complete eye examination by a pediatric ophthalmologist, with extra time spent examining how their eyes focus and move. The exam may include the following:
Other factors to consider that help determine the cause and treatment of strabismus:
There is a variety of treatment options for strabismus. Your eye care provider will discuss which options are best for your specific situation. Treatment options include:
You’ll need to see your provider for follow-up to see if you’ve responded to treatments. Your provider will make any needed adjustments.
No, you can’t prevent strabismus. But you can make sure any eye condition is found early by asking your child’s healthcare provider to do some testing if you suspect strabismus.
For children and adults, it’s important to follow the appointment schedule your eye care provider recommends.
If your child has strabismus, getting a diagnosis and treatment can result in excellent vision and depth perception. Treatment can also protect against loss of vision.
But you can get strabismus treatment at any age, even if you’re an adult.
If you suspect your child has misaligned eyes, or your eyes are misaligned, make an appointment with an eye care provider. There are successful treatments for strabismus.
You should always contact a healthcare provider if you have an eye injury or notice a sudden change in vision.
A note from Cleveland Clinic
If you have a new baby, you probably spend a lot of time looking at them. At first, their eyes have a lack of focus, but that gradually changes. But if you have any questions about your child’s eyes or eyesight, be sure to ask your healthcare provider. Your baby doesn’t need to be able to respond for your provider to do a strabismus test, a condition in which eyes are misaligned. If you or your baby have misaligned eyes, remember that strabismus can be treated successfully. Your provider can offer you more information about your unique situation.
Last reviewed by a Cleveland Clinic medical professional on 06/20/2023.
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