What Causes Strabismus in Children?

Seeing your child’s eyes misaligned can be worrying. But rest assured that it’s treatable, especially when addressed early.

This condition is called strabismus, which is also referred to as  “crossed eyes” or “wandering eye.” It’s a condition where one or both eyes turn inward, outward, upward, or downward.¹

Crossed eyes can drastically affect your child’s vision and depth perception. In this article, we’ll cover everything you need to know about strabismus in children.

What Are the Signs of Strabismus in Children?

The most common signs of strabismus you might notice in a child include:¹

• Visible eye misalignment. This is often the most noticeable sign; this can happen constantly or at certain times.
• Double vision. Your child might start complaining about seeing double, especially when looking at things up close.
• Head tilting or turning. They might try tilting or turning their head to see better.
• Squinting or closing one eye. They might try to squint or close one eye to reduce double vision and improve focus.

What Causes Strabismus in Children?

While doctors don’t know the exact cause, strabismus may stem from different factors. The most common causes of strabismus in children typically include:

• Muscle imbalance. Weak eye structure or hyperactive eye muscles can prevent proper eye control, leading to misalignment.
• Refractive Errors. Significant farsightedness, nearsightedness, or astigmatism not corrected with glasses can sometimes cause strabismus.
• Family History. Strabismus can run in the family, they could have inherited a muscle weakness or refractive error.
• Medical Conditions. Certain neurological conditions can affect the eye muscles and their control.

How Do Doctors Diagnose Strabismus in Children?

A pediatric ophthalmologist (a special eye doctor for children) can diagnose strabismus. They’ll do thorough eye exams that may include:

• Visual tests. Assesses each eye’s visual acuity and focusing ability
• Cover tests. Used to observe how the misaligned eye moves when the other eye is covered
• Cover-Uncover Test. Similar to the cover test, but the occluder is moved back and forth between the eyes to detect misalignment
• Eye dilation: Thoroughly examines the internal eye structure
• Light Reflex Test. Also known as the Hirschberg test, involves shining a light into the child’s eyes and observing the reflection on the corneas to check for alignment
• Prism Cover Test. Involves placing prisms of varying strengths in front of the eye to quantify the angle of deviation

None of these tests are invasive or uncomfortable for children. However, some children may feel anxious about doctor’s visits, even if it’s just a simple eye exam. The best thing to do is to help them stay calm and comfortable or inform your ophthalmologist that they may feel slightly anxious.

Is Strabismus in Children a Serious Condition?

Although strabismus isn’t life-threatening, it can have significant consequences if it isn’t treated. These consequences include:³

• Amblyopia. Causes the brain to ignore signals from the weaker eye, making treatment less effective
• Depth perception issues. Children with misaligned eyes can have difficulties with depth perception, which can affect tasks like running, playing, or sports
• Self-esteem. Strabismus can impact a child’s appearance, which can lead to problems with their social life and confidence

Luckily, strabismus is highly treatable, especially when detected early on. Your child can correct their vision problems without too much fuss if you can work on it with them as soon as possible.

What Are the Treatment Options for Children with Strabismus?

Strabismus is important to treat early, as it can affect how your child’s vision develops. The good news is that there are effective treatment options:⁵

• Eyeglasses or contact Lenses. These can fix vision problems that may contribute to crossed eyes
• Eye patches. Covering the stronger eye with a patch forces the brain to use the weaker eye
• Eye exercises. These exercises may help improve eye-muscle coordination 
• Surgery. In some cases, surgery may tighten or loosen the muscles for better alignment

Outlook for Children with Strabismus

Most children with strabismus do very well with early treatment. This can help give them good eye alignment, vision, and depth perception. It’s also good for preventing vision loss.

Can Eye Exercises Help Children with Strabismus?

Eye exercises can be a helpful part of treatment, but they don’t usually fix strabismus on their own. Your child’s eye doctor will recommend the best combination of treatments for eye alignment.

Remember to be supportive and patient with your child when they’re trying to realign their vision. Some eye exercises may not be their favorite thing to do and it may get frustrating for them, so you can do it with them or encourage them when they’re doing it.

Your child can do some exercises at home, but others should be done at the doctor’s office. These exercises sometimes require special equipment, such as:⁴

• Lenses
• Prisms
• Filters
• Occluders
• Computer programs

Some examples of eye exercises that a doctor might prescribe include:

Pencil Push-ups

Have your child hold a pencil at arm’s length from their face, and then have them slowly move it closer to their nose. Instruct them to follow the pencil with their eyes and move it away when they start to see two pencils. Repeat the exercise several times a day.

Brock String

This method uses three different colored beads at equal distances on a 5-foot string. Have your child hold one end of the string to their nose and secure the other end.

Tell them to focus on the bead closest to their nose until they see it as a single object, and the string forms a V shape. Next, they should shift their focus to the next bead, where the string appears to form an X through the center bead.

Repeat with the third bead. They should see the string form an inverted V-shape.

Barrel Cards

Each card has three barrels of different sizes on it. The barrels are red on one side of the card and green on the other.

Have your child hold the card against the bridge of their nose with the smallest barrel closest to them. One eye should see the red barrels, and the other should see the green ones. Tell them to focus on the barrel farthest from their nose, they should see the red and green barrels form one image.

Let them focus on it for five seconds, then have them shift focus to the middle barrel until they see the colored barrels overlap into one image. Repeat this process for the nearest barrel until they’ve done all three barrels.

Computer Programs

Your doctor may have specially designed computer programs that use virtual reality and video games to correct depth perception caused by strabismus. Your doctor can customize these programs for your child. These programs are usually done in the office.

Summary

Strabismus (crossed eyes) is an eye condition where the eyes aren’t properly aligned. Factors like muscle imbalances, refractive errors, genetic factors, or other underlying medical conditions can cause it.

Signs of strabismus include visible eye misalignment, double vision, and head tilting. Early diagnosis and treatment can help correct strabismus.

Fortunately, strabismus isn’t a serious condition. However, if it isn’t treated early, it can lead to long-term eye complications.