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Strabismus in Babies

It’s normal for a newborn’s eyes to wander or cross occasionally during the first few months of life. But by the time a baby is 4 to 6 months old, the eyes usually straighten out. If one or both eyes continue to wander in, out, up, or down — even intermittently —it’s probably due to a condition called strabismus.

When detected early on, strabismus is curable through a variety of safe and effective treatment options. But it’s important for kids to be treated early — waiting too long or overlooking treatment completely can lead to permanent vision loss.

Infantile esotropia is a type of strabismus that occurs in premature babies. When the muscles that surround and control the eye don’t work together, it causes the eyes to point in different directions. Strabismus is thought to occur in premies because the baby’s brain hasn’t developed enough to control the eye muscles. Other factors related to strabismus in babies include:

  • Brain or nerve disorders, including water on the brain, bleeding in the brain, seizure disorders, cerebral palsy, and other conditions
  • Retinal damage from ROP
  • A buildup of blood vessels under the skin (hemangioma) near the eye
  • Brain or eye tumors
  • A cataract or eye injury
  • Developmental delay

Children with any of these conditions should be examined by a pediatric eye care specialist. Also contact the doctor if you notice that your child’s eyes are crossing.

Complications of Strabismus

Because the eyes focus in two different areas, the brain receives two different images. To compensate, the brain ignores the image from the crossed eye and perceives the image from the straighter eye. This can affect depth perception.

Strabismus can also lead to amblyopia, or lazy eye. This occurs when the crossed eye doesn’t develop good vision and may even lose vision. About one-third of children with strabismus develop amblyopia.

Signs & Symptoms

Most kids with strabismus don’t complain of eye problems. Usually, it’s a family member or teacher who notices a misalignment of the eyes.

Some kids may complain of double vision (seeing two objects when there’s only one in view) or have trouble seeing things in general. Younger children who are not yet able to verbalize their vision problems may squint frequently and turn or tilt their heads in an attempt to see more clearly.

If your child has any of these signs or symptoms, tell your doctor. If necessary, he or she can refer you to a pediatric ophthalmologist for proper evaluation and treatment.

Strabismus Treatment

Treatment for strabismus depends on the underlying cause and the severity of the eye misalignment. The condition usually is corrected with either glasses or eye muscle surgery. In some cases, the use of eye patching or eye drops may be helpful too.

Farsightedness (hyperopia), nearsightedness (myopia), and astigmatism (a form of blurry vision) can sometimes cause crossed eyes in very young children. These kids might benefit from wearingglasses.

A child who has amblyopia as well as strabismus might be prescribed eye patches to be worn over the unaffected or straight eye. These block out all light and force the misaligned or weaker eye to do the “seeing” work. Over time, consistent patching may strengthen the vision in the weaker eye. Sometimes it can help strengthen the muscle of the weaker eye and restore proper alignment.

Typically, kids must wear the patch 2 to 3 hours per day during waking hours for several months or years depending on the severity of the condition. In more extreme cases, patches may be worn up to 6 hours or longer every day.

For parents of babies and toddlers with strabismus, enforcing the use of an eye patch can seem challenging. But after the initial adjustment period, most kids adapt well and the patch just becomes part of their daily routine, like brushing their teeth.

Sometimes, though, despite a parent’s best efforts, a child will refuse to wear an eye patch. In these cases, atropine drops might be used instead. Just as an eye patch blocks the vision in the unaffected or straight eye, the atropine drops will temporarily blur out vision in the straight eye, forcing the misaligned eye to work harder.

If glasses and/or patching or atropine drops do not achieve the proper alignment, eye muscle surgery may be recommended. Surgery involves loosening or tightening the muscles that cause the eye to wander. Although it is an invasive measure, surgery is considered safe and effective and usually does not require an overnight hospital stay.

Once vision has stabilized, surgery repairs the muscles around the eye. You may hesitate to put your child through surgery at a young age. However, treating strabismus before age 2 has been shown to have better long-term results than waiting until a child is older.

Even after surgery a child may still need glasses. Because the strabismus can return, be sure your child has eye exams as recommended by a pediatric ophthalmologist.


How well children fare with correction of strabismus depends not only on the severity of their condition, but also on how quickly it was recognized and treated.

Kids reach full visual maturation at around 8 years old. It is during these early years of development that vital connections between the eyes and the brain are formed. So early intervention is critical. The earlier strabismus is diagnosed and treated, the better a child’s chances are of having straight eyes and developing good vision and proper depth perception. Studies show, however, that older kids and teens and even many adults with strabismus might still benefit from treatment.

The social aspect to strabismus also should not be overlooked. Properly aligned eyes are important for a healthy self-image and good interpersonal relationships in kids and adults.

Fortunately, when strabismus is recognized and treated effectively, it can be cured and permanent vision loss prevented.

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