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Strabismus refers to misaligned eyes. Esotropia (“crossed” eyes) occurs when the eyes turn inward. Exotropia (“wall-eye”) occurs when the eyes turn outward. When one eye is higher than the other, it is called hypertropia (for the higher eye) or hypotropia (for the lower eye). Strabismus can be subtle or obvious, and can occur occasionally or constantly. It can affect one eye or shift between eyes.

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Strabismus usually begins in infancy or childhood. Some toddlers have accommodative esotropia. Their eyes cross because they need glasses for farsightedness. But most cases of strabismus do not have a well-understood cause. It seems to develop because the eye muscles are uncoordinated and do not move the eyes together. Acquired strabismus can occasionally occur because of a problem in the brain, an injury to the eye socket, thyroid eye disease or other problem. Any new-onset strabismus in a child needs prompt attention to rule-out a serious problem in the eye or brain.

When young children develop strabismus, they typically are not bothered by it too much. They may hold their heads to one side if they can use their eyes together in that position. Or, they may close or cover one eye when it deviates, especially at first. Adults, on the other hand, have more symptoms when they develop strabismus or when their strabismus worsens. They have double vision and may lose depth perception. At all ages, strabismus is a problem. Studies show school children with significant strabismus have self-image problems.

Amblyopia (“lazy eye”) is closely related to strabismus. Children learn to suppress double vision so effectively that the deviating eye gradually loses vision – the brain essentially turns it off, and so the neurological connection between the eye and the brain does not develop properly, due to lack of use. It may be necessary to patch or put drops in the good eye in order to force the amblyopic eye to be used. Glasses are often necessary. Amblyopia does not occur when alternate eyes deviate, and adults do not develop amblyopia.

Strabismus is often treated by surgically adjusting the tension on the eye muscles. The goal of surgery is to get the eyes close enough to perfectly straight that it is hard to see any residual deviation. Surgery usually improves the condition, though the results are often not perfect. Results are usually better in young children. Surgery can be done with local anesthesia in some adults, but requires general anesthesia in children, usually as an outpatient. Prisms and Botox injections of the eye muscles are alternatives to surgery in some cases. Eye exercises are rarely effective in most types of strabismus.

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