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Crossed Eyes: Understanding Strabismus




What's the difference between crossed eyes and strabismus? Trick question! They're one and the same.


Put simply, Strabismus is a vision disorder in which the eyes fail to point in the same direction when attempting to focus on an object. The eyes are therefore disassociated, which means they're not working together to maintain binocular vision.


In the normal state, the brain and eye muscles effectively collaborate to remain aligned. A young brain, by its very nature, is still trying to "figure things out", which can cause eyes to cross or drift outwards. This is particularly common in infancy, and is considered normal until age 3-4 months in full-term newborns. In premature infants born at 34 weeks gestational age and younger, crossed eyes can present up to age 4-6 months. However, after this period, the eyes should be capable of looking straight on a consistent basis.

If the eyes of an infant or young child remain misaligned for long, the critical time frame for developing binocular vision may be lost. Also, one or both eyes may become permanently weak in their visual acuity (amblyopia), further complicating the problem.


Types of Strabismus

Pseudostrabismus: Occurs when the eyes are actually aligned normally, but the shape of the eyelid skin or nasal bridge creates an optical illusion of crossed or misaligned eyes. This still warrants a medical eye exam since many times it is difficult to differentiate pseudostrabismus from true strabismus.

Esotropia: Occurs when one eye crosses in towards the nose in relation to the other. There are numerous subtypes of esotropia including congenital esotropia, accommodative esotropia, mixed mechanism esotropia, paralytic esotropia, and Duane’s type esotropia.

Exotropia: Occurs when one eye drifts outward, towards the temple, in relation to the other eye. The subtypes of exotropia include congenital exotropia, intermittent exotropia, paralytic exotropia, and Duane’s type exotropia.

Hypertropia/hypotropia: Occurs when one eye deviates up or down in relation to the other eye.


Causes of Strabismus

Strabismus can occur because of high or unequal refractive errors, amblyopia, hereditary factors, prematurity, spontaneous causes, illness, trauma, brain abnormalities including tumors, and/or thyroid issues.


When strabismus is suspected, a comprehensive medical eye exam with a pediatric eye specialist is very important.

Treatment for Strabismus

Treatment for strabismus may include the use of glasses full-time, bifocals, patching the straight eye for hours a day, instilling a dilating drop in the straight eye a few times per week, surgery of the eye muscles, Botox injection of the eye muscles, or a combination of the above. A child with strabismus is followed closely every 2-6 months until about the age of 9, depending on the severity of the condition.

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