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Advice for Patients
March 1, 2010


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Copyright 2010 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2010

Arch Pediatr Adolesc Med. 2010;164(3):304. doi:10.1001/archpediatrics.2010.22

Strabismus is a condition in which a person's eyes point in different directions. Usually one eye is pointed straight ahead and the other is pointed in, out, up, or down. Some people call this condition being “cross-eyed.” Strabismus may be present all of the time (constant) or only some of the time (intermittent).

With normal vision, both eyes are aimed in the same direction and see the same image. The brain then blends these 2 images together into 1 clear, 3-dimensional image. This is called binocular vision. Children with strabismus often have difficulty with double vision because each eye is seeing a slightly different image. Over time, the brain starts to ignore the image from the turned eye in an attempt to avoid double vision; this is called suppression. Over time, the child may lose depth perception and even lose vision in the turned eye.

Strabismus is one of the most common eye disorders in children. Between 1% and 5% of children younger than 6 years have strabismus.

What causes strabismus?

Strabismus occurs when the movements of one eye's muscles do not match those of the other eye. Most children with strabismus have no other neurologic or medical conditions that would explain the strabismus. A study in this month's Archives issue found that for some children, strabismus is associated with having a neurologic or developmental condition, being born premature or with low birth weight, maternal smoking during pregnancy, and maternal illness during pregnancy. The underlying cause is still unknown.

What are the symptoms of strabismus?

  • Eyes appear to be looking in different directions some or all of the time.

  • For some children, eyes appear to be looking in different directions only when the child feels tired or sick.

  • Some children may turn their head or squint one or both eyes in an attempt to improve their vision.

What should i do if i think my child may have strabismus?

Because early childhood is a critical period in which vision is developed, it is essential to identify and treat strabismus as early as possible so that your child will have normal binocular vision. Strabismus always requires evaluation and treatment; children do not outgrow strabismus. If you are concerned that your child may have strabismus, see your pediatrician.

To evaluate your child for strabismus, your doctor may hold a small light in front of your child's eyes to check whether the reflection of this light is properly centered in each eye. In another test, your doctor covers one of the child's eyes and then the other to see whether the eyes shift abnormally when focusing on a near or distant object.

What is the treatment for strabismus?

If your doctor is concerned that your child has strabismus, the child will be referred to an eye doctor, also called an ophthalmologist. The ophthalmologist might prescribe patching to stimulate the eye that is being suppressed;  this prompts the suppressed eye to work harder and develop normal vision. Eyeglasses may be prescribed to improve focus and vision. In some cases, surgery may be necessary to help the eye muscles move normally. With early diagnosis and treatment, vision can usually be normal.

For more information

US National Library of Medicine and National Institutes of Health http://www.nlm.nih.gov/medlineplus/ency/article/001004.htm

Inform yourself

To find this and other Advice for Patients articles, go to the Advice for Patients link on the Archives of Pediatrics & Adolescent Medicine Web site at http://www.archpediatrics.com.

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The Advice for Patients feature is a public service of Archives of Pediatrics & Adolescent Medicine. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your child's medical condition, Archives of Pediatrics & Adolescent Medicine suggests that you consult your child's physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.