Strabismus

The misalignment results from the failure of the eye muscles to work together. One eye, or sometimes both, may turn in (crossed eyes), turn out (wall eyes), turn up or turn down. Sometimes more than one of the 'turns' are present.

The deviation may be constant or it may come and go. In young children strabismus may vary not only from day-to-day, but during the course of a day.

At birth, an infant's eyes cannot always focus directly on objects. They may appear to move quite independently at first, sometimes crossing, and sometimes wandering outward. But by the age of three to four months, an infant's eyes should have the ability to focus on small objects and the eyes should be straight or parallel. A six-month-old infant should be able to focus on both distant and near objects.

If parents notice crossed or wall eyes persisting in a child four months of age, they should immediately take the child to an eye care professional for an examination. Early medical attention is recommended for another important reason—to rule out the presence of a serious disease, such as a tumor.

During regular well baby exams, from birth to 2 years of age, pediatricians should use history and a vision evaluation to see if vision problems exist.

If there is any concern of an eye or vision problem the child should be referred for a comprehensive professional eye examination by an eye doctor.

Is strabismus present at birth?

Strabismus may be present at birth, it may become apparent at a later age or it may appear at any time in life as a result of illness or accident.

Approximately two percent of the nation's children have strabismus. Half of them are born with the condition.

It is critical that this condition be diagnosed and corrected at an early age since children with uncorrected strabismus may go on to develop amblyopia.

Certain children may appear to have strabismus when, in fact, they do not. An extra fold of skin near the inner eye, a broad, flat nose or eyes that are unusually close together may also produce the effect of false (or pseudo) strabismus. False strabismus should disappear as the child's face grows.

After an eye exam by an eye doctor, a parent's concern can be quickly dispelled if false strabismus is present.

Strabismus cannot be outgrown, not will it improve by itself. Treatment to straighten the eyes is required. The types of treatments may be used alone or in combination, depending on the type of strabismus and its cause.

• Glasses are commonly prescribed to improve focusing and redirect the line of sight, enabling the eyes to straighten.
   
• Medication in the form of eye drops or ointment may be used, with or without glasses. Injected medication may be used to selectively weaken an overactive eye muscle.
   
• Surgery may be performed on eye muscles to straighten the eyes if nonsurgical means are unsuccessful.
   
• An eye doctor may recommend eye exercises either before or after surgery.