You notice one of your child’s eyes drifting outward in photos. Or maybe you’ve been seeing double after a long day and aren’t sure if it’s just fatigue. Either way, something about the way the eyes are working together feels off, and you want answers.
Strabismus, commonly called crossed eyes or wandering eyes, is one of the most misunderstood eye conditions out there. Some people assume it’s purely cosmetic. Others don’t realize adults can develop it, or that leaving it untreated can have real consequences for vision.
This post covers what strabismus actually is, what causes it, how to recognize the signs in both kids and adults, and what treatment options are available. By the end, you’ll have a clear picture of when to act and what to expect.
What Is Strabismus?
Strabismus is a condition where the eyes don’t point in the same direction at the same time. One eye may turn inward (esotropia), outward (exotropia), upward (hypertropia), or downward (hypotropia). It can be constant or intermittent, and it can affect one eye or alternate between both.
Normally, six muscles attached to each eye work together to keep both eyes aimed at the same target. When these muscles are imbalanced or when the brain has trouble coordinating them, the eyes fall out of alignment. The brain receives two different images instead of one unified picture, which it handles by either seeing double or, over time, suppressing the signal from the misaligned eye entirely.
That suppression is what makes early treatment so important. If the brain learns to ignore one eye, vision in that eye can deteriorate, leading to amblyopia (lazy eye).
What Causes Strabismus?
Strabismus doesn’t have a single cause. It can develop for different reasons depending on age and individual health factors.
In Children
Most cases of strabismus in children are congenital, meaning they’re present at birth or develop within the first few years of life. In many of these cases, the exact cause isn’t clear. However, there are known contributors: a family history of strabismus, significant uncorrected farsightedness (which forces the eyes to work harder to focus and can trigger inward turning), and neurological differences that affect how the brain controls eye movement.
Conditions like cerebral palsy, Down syndrome, and premature birth are also associated with a higher likelihood of strabismus.
In Adults
Adults can develop strabismus even with no childhood history of it. Strokes, head injuries, and brain tumors can all disrupt the nerves that control eye muscles. Thyroid eye disease (Graves’ disease) can cause the muscles around the eye to swell and restrict movement. Diabetes and high blood pressure can affect the blood vessels supplying those nerves. In some cases, strabismus re-emerges in adulthood in people who had it as children but whose eyes had been well-aligned for years.
Recognizing the Signs of Strabismus
The most obvious sign is visible eye misalignment, but not all cases are that straightforward, especially with intermittent strabismus, where the eye only drifts sometimes.
Signs in Children
Watch for an eye that turns in or out, especially when the child is tired, sick, or concentrating. Squinting in bright light, tilting or turning the head to look at things, and covering one eye to see better are all behaviours that can point to strabismus or a related vision problem. Some children will complain that things look blurry or that they’re having trouble judging depth, though younger kids often can’t articulate what’s wrong.
It’s worth knowing that a newborn’s eyes can look slightly crossed in the first few months, which is usually normal. But if the misalignment persists past four to six months, it’s time to get it checked.
Signs in Adults
Double vision is one of the most common complaints when strabismus develops or returns in adulthood. You might also notice eye strain, headaches, or difficulty reading. Some adults notice their eyes drifting in photos and only realize it’s happening consistently when someone else points it out. New-onset double vision in an adult should always be evaluated promptly, as it can signal a neurological issue that needs attention beyond just the eyes.
Strabismus vs. Lazy Eye: What’s the Difference?
These two conditions often get confused. Strabismus is a misalignment of the eyes. Amblyopia (lazy eye) is reduced vision in one eye because the brain has stopped fully processing its signals. The two frequently occur together: strabismus can cause the brain to suppress the weaker eye’s input, which then leads to amblyopia. But amblyopia can also exist without any visible eye turn.
Treating them often overlaps, but they’re not the same thing, and it’s important to address both when they’re present.
How Is Strabismus Diagnosed?
Diagnosis involves a comprehensive eye exam that assesses eye alignment, how well each eye focuses, and how well the eyes work together as a team. An optometrist or ophthalmologist will use tools like a cover test (alternately covering each eye to observe whether the uncovered eye moves to take up fixation), a Hirschberg light reflex test, and prism measurements to determine the degree and direction of any misalignment.
In children, this is typically done as part of a routine pediatric eye exam. Kids don’t need to be able to read a chart for an exam to be thorough; there are ways to assess young children’s vision without verbal responses. Early screening matters, and a comprehensive exam at LMC Optometry & Eye Care can detect misalignment that a standard school screening might miss.
Strabismus Treatment Options
The good news is that strabismus is treatable, and the options have expanded considerably over the years.
Glasses and Prism Lenses
For strabismus caused by uncorrected farsightedness, prescription glasses can often correct the alignment issue entirely. When the eyes no longer have to strain to focus, the inward turning resolves. Prism lenses are another tool: they bend light before it enters the eye, reducing the brain’s need to compensate for misalignment. They don’t cure strabismus but they can eliminate double vision and make daily life much more comfortable while other treatments are underway.
Vision Therapy
Vision therapy is a structured program of exercises designed to retrain the visual system, improve eye coordination, and build the brain’s ability to use both eyes together. It’s most effective when there’s some underlying binocular function to work with, and it’s typically used alongside other treatments. At LMC Optometry & Eye Care, patients who need vision therapy receive it through our partner clinic Individual Eyes in Richmond Hill, which specializes in this area.
Patching and Atropine Drops
When strabismus has led to amblyopia, patching the stronger eye or using atropine drops to blur it forces the brain to rely on the weaker eye, which helps restore vision. This approach addresses the amblyopia rather than the strabismus directly, but the two are often treated in parallel.
Botulinum Toxin Injections
Botulinum toxin (Botox) injected into an overactive eye muscle can temporarily weaken it, allowing the opposite muscle to pull the eye back into alignment. This is sometimes used as a standalone treatment for small-angle strabismus, or as a temporary measure while the visual system recovers from a neurological event.
Strabismus Surgery
Surgery is often recommended when the misalignment is too large to correct with glasses or therapy alone, or when it hasn’t responded adequately to non-surgical methods. The surgeon adjusts the length or attachment point of one or more eye muscles to shift the eye’s resting position. It’s done under general anaesthesia in children and sometimes under local anaesthesia in adults. More than one procedure may be needed to achieve full alignment, and glasses or vision therapy are often still part of the picture after surgery.
What Happens If Strabismus Goes Untreated?
In children, the consequences can be significant. The brain will suppress the misaligned eye to avoid double vision, and if that suppression continues long enough, vision in that eye can permanently decline. The earlier strabismus is caught and treated, the better the outcome for long-term vision.
In adults, untreated strabismus can mean persistent double vision, difficulty driving or reading, and social self-consciousness. Quality of life is genuinely affected, even if the risk of permanent vision loss is lower than in children.
When to See an Eye Doctor
If you notice a child’s eye turning in any direction, even occasionally, book an eye exam. Don’t wait to see if it resolves on its own past the first few months of life. For adults, new-onset double vision or a noticeable change in eye alignment deserves prompt attention, especially if it came on suddenly.
If you’re searching for an optometrist near me in the Barrie, Thornhill, or Brampton area, the team at LMC Optometry & Eye Care can assess alignment issues in both children and adults, and guide you toward the right next step.
Frequently Asked Questions on Strabismus Treatment
Can strabismus be cured completely?
In many cases, yes, especially when caught early in children. Glasses alone can resolve accommodative esotropia. Surgery and vision therapy can achieve lasting alignment in many patients. That said, some people require ongoing management or multiple treatments.
Is strabismus hereditary?
There is a genetic component. Having a parent or sibling with strabismus increases your child’s risk, which is a good reason to have children’s eyes examined early even if you don’t see an obvious turn.
Can adults develop strabismus out of nowhere?
Yes. Strokes, head injuries, thyroid disease, and diabetes are among the causes of new-onset strabismus in adults. Any sudden change in eye alignment or new double vision should be evaluated by a doctor.
Does strabismus get worse with age if untreated?
It can. In children, the bigger concern is vision loss from amblyopia. In adults, the degree of misalignment may remain stable, or it may drift depending on the underlying cause.
What’s the difference between intermittent and constant strabismus?
Intermittent strabismus means the eye only drifts some of the time, often when the person is tired or spacing out. Constant strabismus means the eye is always misaligned. Intermittent forms can still cause amblyopia and are worth treating.
Is vision therapy effective for strabismus?
It can be, particularly for intermittent exotropia and for building binocular vision after surgical alignment. It’s not a standalone solution for all types, but it plays an important role in many treatment plans.
Take the Next Step
Strabismus is more common than most people realize, and it’s much more manageable when it’s caught early. Whether you’ve noticed something off in your child’s eyes or you’re dealing with new double vision yourself, an eye exam is the right starting point.
At LMC Optometry & Eye Care, we offer comprehensive eye exams for patients of all ages, including thorough assessments of eye alignment and binocular function. We can help you understand what’s going on and point you toward the right care.
