• Strabismus

    (Tropia; Crossed Eyes)


    Strabismus is a misalignment of one or both eyes. It prevents both eyes from focusing on the same point at the same time. Prompt treatment is needed to avoid vision problems, including blindness.
    The names associated with strabismus are based on the type, and direction and appearance of the eye.
    Strabismus can be:
    • Constant—the eye turns all the time
    • Intermittent—the eye turns only some of the time, like in times of stress, illness, concentration, or when tired
    Direction of the eye:
    • Hyper—eye turns upward
    • Hypo—eye turns downward
    • Exo—eye turns outward (away from the nose)
    • Eso—eye turns inward (toward the nose)
    Appearance of the eye:
    • Tropia—can be seen when both eyes are open
    • Phoria—can be seen only when one eye is covered
    Exotropia of the Left Eye
    factsheet image
    Copyright © Nucleus Medical Media, Inc.


    Eye movement is a coordination of muscles and nerves that support the eye. Strabismus is normal in infants (4-6 months old) until the eyes straighten out. It can be present at birth or develop during the course of childhood. Some causes of strabismus include:
    • Visual problems with the eyes, like cataracts or farsightedness
    • Problems with the muscles and/or nerves that support the eyes
    • Trauma (more likely in adults)
    • Tumors (rarely)
    In most cases, the cause of strabismus is unknown.

    Risk Factors

    Strabismus is most common in children, but it may occur in adults. Other factors that may increase the chance of strabismus include:
    • Family members with strabismus
    • Diabetes
    • Thyroid disorders
    • Retinopathy of prematurity
    • Vision impairment in one eye—the affected eye will often turn in or out


    Strabismus may cause:
    • Crossed eyes
    • Eyes that do not align properly
    • Uncoordinated eye movements
    • Double vision
    • Problems with depth perception
    • Eye strain, which may cause headaches or blurred vision
    • Squinting
    • Favoring a certain head position
    Many aspects of strabismus are noticed by other people.


    The doctor will ask about any symptoms, and medical and family history. A physical exam will be done. In general, misalignments of the eye can be seen. An eye specialist will test the eyesight and look for other abnormalities. A neurological exam can help rule out other causes.


    Treatment may include:


    Glasses or contact lenses may be prescribed for the eye with weaker vision. The prescription lens improves the ability to focus and helps with poor vision. Better eyesight may help with improving strabismus. For some conditions, special prism lenses can be placed in the glasses. The prism will help to reduce double vision that may occur.


    In children, an eye that is not properly aligned may not mature properly. If this is not corrected, permanent vision loss can occur. In some cases, a patch is applied over the unaffected eye. This forces the child to fixate and use the affected eye. This will help the visual development in that eye. The length of time the patch is worn depends on the severity of the condition and the age of the child.


    Eye drops or ointment may be put in the good eye to temporarily blur the vision. This also forces the affected eye to fixate properly. These drops may be used as a substitute for patching.
    Injections of botulinum toxin may also be used to treat strabismus caused by muscle imbalances. The injections are used to partially paralyze the muscle pulling the eye in the wrong direction.


    Surgery may be used to straighten the eyes if nonsurgical means are not successful. The surgery may shorten certain eye muscles of move some of them into a new location. This may improve the ability of the eye muscles to keep the eyeball in its proper place.


    There are no current guidelines to prevent strabismus. If you notice that you or your child’s eyes are not properly aligned, visit your eye doctor right away.


    American Academy of Ophthalmology http://www.aao.org

    National Eye Institute (NEI) http://www.nei.nih.gov


    Canadian Association of Optometrists https://opto.ca

    Health Canada http://www.hc-sc.gc.ca


    Strabismus. American Association of Pediatric Ophthalmology and Strabismus website. Available at: http://www.aapos.org/terms/conditions/100. Updated March 28, 2014. Accessed March 21, 2016.

    Strabismus. Merck Manual Professional Version website. Available at: Updated December 2012. Accessed March 21, 2016.

    Strabismus. Nemours Kids Health website. Available at: http://kidshealth.org/en/parents/strabismus.html. Updated October 2013. Accessed March 21, 2016.

    What is strabismus? American Academy of Ophthalmology website. Available at: http://www.aao.org/eye-health/diseases/what-is-strabismus. Updated April 14, 2014. Accessed March 21, 2016.

    Revision Information

  • LiveWell personal health survey

    How healthy are you really? Find out – free.Learn more

    It's time to stop guessing. If you want to make some changes but just aren't sure how, the free personal health survey from LiveWell is a great place to start.

  • HeartSHAPE Spotlight

    At risk for a heart attack? Learn more

    Fight heart disease and prevent heart attacks. HeartSHAPE® is a painless, non-invasive test that checks pictures of your heart for early-stage coronary disease.

  • Calories and Energy Needs

    Calorie NeedsLearn more

    How many calories do you need to eat each day to maintain your weight and fuel your physical activity? Enter a few of your stats into this calculator to find out.

  • Ideal Body Weight

    Ideal Body WeightLearn more

    Using body mass index as a reference, this calculator determines your ideal body weight range. All you need to do is enter your height.

  • Body Mass Index

    Body Mass IndexLearn more

    This tool considers your height and weight to assess your weight status.

  • Can we help answer your questions?

    Wellmont Nurse Connection is your resource for valuable health information any time, 24 hours a day, seven days a week. Speak to a Nurse any time, day or night, at (423) 723-6877 or toll-free at 1-877-230-NURSE.