What Is Strabismus?

Strabismus is a disorder in which the eyes do not line up together. Because they are separately focused they do not look at the same thing at the same time. This is both a visual problem and an aesthetic problem. Generally speaking, people with strabismus are called cross-eyed, or lazy-eyed, but this does not always describe what is actually happening.

Strabismus can impact just one eye, or both. According to the American Academy of Ophthalmology, ‘one eye may look straight ahead, while the other eye turns inward, outward, upward, or downward. The eye turn may be consistent, or it may come and go. Which eye is straight (and which is misaligned) may switch or alternate.’

Who Gets Strabismus?

Who Gets Strabismus

The three most common types of strabismus are:


  • Esotropia, which is a very common form of strabismus in children. This is when the eyes cross, or rather, one turns toward the nose rather than straight. This is most common in infants, toddlers and really young children.


  • Exotropia, or wall-eye, is where one eye turns outward toward the ear. This usually occurs with children between the ages of 1 and 6 years old.


  • Hypertropia, is also known as vertical deviation. This is where one of the eyes turns upward, toward the hairline.


The disorder usually impacts infants and children, but it can occur in adults that have suffered from botulism, Graves disease, shellfish poisoning, traumatic brain injury, diabetes, Guillain-Barre syndrome, an injury to the eye, or vision loss from another disease or injury. (Source). In children, having a family history of strabismus is an indicator of risk. It also has a tendency to occur in children who have other physiological disorders that affect the brain such as cerebral palsy, down syndrome, hydrocephalus, brain tumors or prematurity. (Source).


In each eye there are six muscles that work together to orient the eyes on any object or view. If a person has strabismus, the muscles do not function together causing one eye to look at one object and the other to turn in a different direction (up, down, or to the side) and focus elsewhere. This is usually because of muscle control, not strength of the muscles. (Source). It causes complications with the way the brain processes information, as it is getting different images from each eye. Symptoms include double vision, crossed eyes, wandering eyes, uncoordinated eye movements or loss of vision or depth perception. (Source)

The Impact of Strabismus

The Impact of Strabismus

Malalignment of the eyes can cause several things to happen:


  • Double vision, or diplopia, develops because the eyes are not aimed at the same place and two images are being sent to the brain.


  • Suppression, or strabismic amblyopia, can occur when the brain ignores the information from one eye in order to avoid double vision. This may cause vision loss if the same eye is suppressed consistently.


  • Anomalous retinal correspondence occurs when the brain develops a new match for each eye even though they are not focused on the same thing. This typically only occurs in very young children.


It is important to have strabismus diagnosed and treated early, to prevent permanent damage to not only the eyes, but to the brain. When strabismus is diagnosed the doctor may try corrective lenses and other treatments, but if there is not improvement, surgery will be necessary to make the muscles in the eyes move correctly. However, it is very important to understand that eye muscle surgery cannot repair poor vision problems, so even after a successful surgery, it may be necessary to wear corrective lenses. (Source).

Strabismus Surgery

Strabismus Surgery

Strabismus surgery changes the alignment of the eyes by loosening or tightening the eye muscles. The procedure is performed under anesthesia in an outpatient setting. Following the surgery the eyes will be red and irritated for several days to several months. The surgeon may prescribe ointments or drops to help with this.


The muscles that are operated on are attached to the wall of the eye, or sclera, and are covered with the thin and transparent tissue conjunctiva. The surgeon holds open the eyes with a small speculum and makes an incision in the conjunctiva, then uses a delicate hook to find the muscle.  If a recession is performed the muscle is detached from the eye and reattached further back from the front; if a resection is performed, then the muscle is shortened but reattached at its original point. (Source). This allows for either more or less functionality of eye movement.

Like any procedure on the eye it is critical to maintain good eye hygiene in advance to reduce any risks of infection. One of the best ways to do this is with daily use of Cliradex. This will not only help to keep the skin, brows, and eyelashes around the eye clean, but will help to eliminate any demodex mites that are residing on the face and in the eyelashes. Demodex can cause aggravations and irritations that could complicate the healing process.