What is Strabismus?

Strabismus, more commonly known as cross-eyed or wall-eyed, is a vision condition in which a person can not align both eyes simultaneously under normal conditions. One or both of the eyes may turn in, out, up or down. An eye turn may be constant (when the eye turns all of the time) or intermittent (turning only some of the time). Strabismus in children does not go away on its own and strabismus in adults is treatable, so strabismus treatment is necessary.

Strabismus in Children

It is estimated that up to 5 percent of all children have some type or degree of strabismus. Children with strabismus may initially have double vision. This occurs because of the misalignment of the two eyes in relation to one another. In an attempt to avoid double vision, the brain will eventually disregard the image of one eye (called suppression). Children do not “outgrow” eye turns! Strabismus treatment is needed!

It is often asked at what age should strabismus treatment no longer be attempted. The answer is, everyone deserves treatment! Age should not be a deterrent.

Does the Person Have Constant or Intermittent Strabismus?

This is one of the most important findings the eye doctor makes! It is important for you as a parent or patient to understand the difference between constant and intermittent strabismus. This distinction has great bearing on timing and types of treatment.

When the eye turn occurs at all distances and at all times, it is called constant strabismus. When the eye turn occurs only some of the time, it is called intermittent strabismus or alternating strabismus. With intermittent strabismus, the eye turn might be observed only occasionally, such as during stressful situations or when the person is ill. Up to the first 6 months of age, intermittent strabismus is a normal developmental milestone. After 6 months, it needs to be evaluated.

Treatment of Constant Strabismus

Constant turns are to be dealt with immediately if one wants to re-establish proper use of both eyes. Treatment for this condition should be early and aggressive. If the eye turn is constant and simple things like patching, drops, and/or glasses (bifocal, prismatic, etc) do not eliminate the eye turn, Vision Therapy, Orthoptics, or Surgery needs to be considered.

Keep in mind that ophthalmologists are eye surgeons and they infrequently offer or recommend Vision Therapy or orthoptics as treatment options. See Is Eye Muscle Surgery the Only Strabismus Treatment?

Treatment of Intermittent Strabismus

With intermittent strabismus, the eye does not turn in all the time, so the brain is probably receiving adequate stimulation for the development of binocular vision.

After 6 months of age, this condition does need attention, but neither the eye doctor nor parent needs to panic. As long as the eyes are straight some of the time, the brain will develop normal functioning of the eyes (stereoscopic depth perception). Children with intermittent eye turns should be handled with judicious patching, special glasses, and/or Vision Therapy. Surgery, if considered at all, should be a last resort. See Eye Muscle Surgery as Treatment for Strabismus, including Intermittent Exotropia

A Parent’s Choice re: Treatment for Intermittent Exotropia

Read what several parents have written regarding making the choice between Strabismus Eye Muscle Surgery or Vision Therapy for Intermittent Exotropia and Lazy Eye.