Children Strabismus

Children Strabismus (Crossed Eyes) is one of the common conditions that occur in Children. This condition is characterized by a misalignment of the eyes, causing them to be aligned in different directions, wherein one eye can be turning down, and the other could be turning in any other direction. In this condition, the misalignment may not only restricted to one eye, but it can shift between the two eyes.

What’s the relationship between the eye’s six muscles and Strabismus?

Each eye has six muscles, to move the eye right, left, up, down, and at angles. And in order for the eye to have a normal focus, all of the six muscles should coordinate their functions and work together.

It is important any issues that exist during childhood are medically resolved so that the eyes are aligned properly once again. Otherwise, a condition called amblyopia may occur in adulthood, wherein the misaligned eye would have weaker vision

Causes of Children Strabismus

Oftentimes, this condition is associated with the brain’s inability to completely coordinate the relevant eye muscles, and usually this is the main cause. But when children are diagnosed with Strabismus, this may actually be linked to certain brain disorders such as the following:

  • Cerebral palsy.
  • Down syndrome.
  • Hydrocephalus (extra fluids in the brain).
  • Brain tumor.
  • Premature birth.

Another potential association is that children with Strabismus may have cataracts as the main cause of this condition. However, it’s important to note that most children who have Strabismus don’t have any of those conditions.

Moreover, it’s important to note that when a family member has Strabismus, the child has an increased likeliness of developing it.

How Does Children Strabismus Affect Vision?

In normal sight, the brain receives two images from the two eyes, and then it merges them to form a single 3-D images, and this is how our brains allow us to recognize depth.

In young children who have Strabismus, the brain may be able to ignore the images from the misaligned eye and focus on the image from the non-affected eye.

As for those who have Strabismus after childhood, they do have double vision, because the brain is already trained to receive images from the two eyes, and consequently it’s not able to turn off the images from the affected eye.

Signs of Strabismus

You may tell that your child has Strabismus when you see them looking at different directions at the same time. You may detect other indications when you see that the child is tilting their head to look at a certain object, or is closing one eye to look at it. All of this could be indications that the child is trying to coordinate the functions of the two eyes to look clearly. Another indication could be when the child squints with one eye when exposed to sunlight.

When you detect those signs, it’s better to have your child examined by a pediatric ophthalmologist for a thorough eye examination.


This is a condition that occurs when the child is less than 1 year old, where the eyes may incorrectly look as though they’re crossed. The child can usually outgrow this condition, and it usually happens when the child has a wide and flat nose or a skin fold at the inner eyelid.

We can see here that the eyes do look misaligned, but at the same time, the light reflection is situated in the same place in both eyes.¹ This is Pseudostrabismus.

Here we can see that the reflection of light is different in the two eyes, with the left eye light-reflection being off-center, showing a sign of Strabismus

Types of Strabismus

Infantile esotropia

This is when the child has their eyes crossing inwards.

Accommodative esotropia

This is when one eye is turning inwards in the direction of the nose, when the child focuses on a close or distant object, and this is considered to be the most common type of Strabismus that occurs in children older than 2 years.


This is when one eye turns outwards, or away from the nose. This usually happens when the child is looking at something far away. This can happen particularly when a child is going through a situation of tiredness, sickness, or when the child is daydreaming. Another sign of Exotropia is when a child might squint with one eye when faced with bright sunlight.


There are several ways of treating Children Strabismus. The doctor will recommend you the right treatment based on your child’s age and their eye-alignment condition.

The treatment can be one of the following ways:

  • Glasses.
  • Prisms.
  • Patching or Blurring the misaligned eye to strengthen it.
  • Eye Muscle Exercises.

If glasses, prisms, patching or eye exercises do not help, surgery is recommended. 

Surgery process details

During surgery, a small cut is done in the tissue that covers the eye, in order to reach the relevant muscles. The ophthalmologist then repositions the muscles in order to help the patient focus in a better way. The surgery may be done in one or both eyes, and sometimes, a second surgery is needed to fully align the child’s eyes. 

After the surgery, the child may go back to their normal life after 2 or 3 days.

As with any other surgery, there can be some risks, and although they’re rare, they can be serious. For more information about this matter, you can directly consult your ophthalmologist.

Apart from those rare side effects, the surgery is usually done safely and effectively. At the same time, the doctor may still recommend eyeglasses, patching the eyes, or blurring them, as it’s very important to keep strengthening the muscles to optimize the vision.