Strabismus is a condition in which your eyes point in different directions. Usually one eye is pointed straight ahead and the other is pointed in a different direction.
Some common terms for strabismus are “cross eyed,” which means that one or both eyes turn toward your nose or “wall eyed,” which means one or both eyes turn out toward your ears.
What is the cause?
There are 6 muscles that work together to move your eye. Strabismus can happen when those muscles do not work together. This may be caused by a problem with the muscles around your eye, your nerves, or a problem in your brain. When your eyes do not work together to look at an object, your brain pays attention to the image from one eye and ignores the image from the other eye. Over time you may not be able to see as well out of one eye.
Most people with strabismus are born with it and it tends to run in families. Strabismus may also be caused by:
Eye or head injuries
Stroke and other blood vessel problems
Diseases that affect the nerves or muscles such as cerebral palsy, Down syndrome, multiple sclerosis, myasthenia gravis, or diabetes
Thyroid disease, which causes swelling of the muscles, fat, and soft tissue around and behind your eye and can make your eye push forward
Sometimes the cause of strabismus is unknown.
What are the symptoms?
Symptoms may happen all the time, or only when you are tired or sick. Symptoms may include:
Eyes turned in different directions
Shutting one eye in outdoor light or squinting one or both eyes
How is it diagnosed?
Your healthcare provider will test your vision and ability to follow objects with each eye. Your provider will test if your eyes can work well together by checking for three-dimensional vision. He or she will also examine your eyes for any signs of disease.
How is it treated?
Treatment may include:
Glasses, possibly with prisms.
Eye exercises. These exercises train your eyes to move together and focus on the same object at the same time. Most forms of strabismus do not improve with eye exercises.
Injections. If an overactive eye muscle is the cause of the strabismus, small amounts of botulinum toxin A can be injected into the muscles near the eye. This may weaken or stop the muscles on one side and allow the muscles on the other side to work harder. The shots can last several months and may even cause a permanent change.
Surgery on your eye muscles. Muscles may be loosened, tightened, or repositioned. Strabismus surgery is not cosmetic surgery. Having eyes that are not aligned normally interferes with your ability to communicate with others through eye contact.
More than one surgery may be needed. The success of surgery depends partly on the coordination between your eyes and brain. It needs to be good enough to keep your eyes locked on target and in alignment.
How can I take care of myself?
Follow the full course of treatment your healthcare provider prescribes. Ask your healthcare provider:
How and when you will hear your test results
How long it will take to recover
If there are activities you should avoid and when you can return to your normal activities
How to take care of yourself at home
What symptoms or problems you should watch for and what to do if you have them
Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.
Adult Advisor 2015.1 published by RelayHealth. Last modified: 2014-10-27 Last reviewed: 2014-10-27
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
Eyes Point in Different Directions (Strabismus): References
American Academy of Ophthalmology. 2013-2014 Basic and Clinical Science Course. San Francisco: American Academy of Ophthalmology, 2013; v.1-13.
Miller NR, Newman NJ, Biousse V and Kerrison JB, eds. Walsh and Hoytâ€™s Clinical Neuro-Ophthalmology, 6th ed. Baltimore: Lippincott Williams & Wilkins, 2004;v.1-3.
Yanoff M and Duker JS. Ophthalmology, 4th edition. Philadelphia: Mosby, 2013.