Crossed eyes, or strabismus, is a condition in which both eyes do not look at the same place at the same time. It usually occurs in people who have poor eye muscle control or are very farsighted.
Six muscles attach to each eye to control how it moves. The muscles receive signals from the brain that direct their movements. Normally, the eyes work together so they both point at the same place. When problems develop with eye movement control, an eye may turn in, out, up or down. The eye turning may occur all the time or may appear only when the person is tired, ill, or has done a lot of reading or close work. In some cases, the same eye may turn each time. In other cases, the eyes may alternate turning.
Proper eye alignment is important to avoid seeing double, for good depth perception, and to prevent the development of poor vision in the turned eye. When the eyes are misaligned, the brain receives two different images. At first, this may create double vision and confusion. But over time the brain will learn to ignore the image from the turned eye. Untreated eye turning can lead to permanently reduced vision in one eye. This condition is called amblyopia or lazy eye.
Some babies’ eyes may appear to be misaligned, but they are actually both aiming at the same object. This is a condition called pseudostrabismus or false strabismus. The appearance of crossed eyes may be due to extra skin that covers the inner corner of the eyes or a wide bridge of the nose. Usually, the appearance of crossed eyes will go away as the baby’s face begins to grow.
Strabismus usually develops in infants and young children, most often by age 3. But older children and adults can also develop the condition.
People often believe that a child with strabismus will outgrow the condition. However, this is not true. In fact, strabismus may get worse without treatment. An optometrist should examine any child older than 4 months whose eyes do not appear to be straight all the time.
Strabismus is classified by the direction the eye turns:
- Inward turning is called esotropia
- Outward turning is called exotropia
- Upward turning is called hypertropia
- Downward turning is called hypotropia.
Other classifications of strabismus include:
- The frequency with which it occurs—either constant or intermittent
- Whether it always involves the same eye—unilateral
- If the turning eye is sometimes the right eye and other times the left eye—alternating.
Treatment for strabismus may include eyeglasses, prisms, vision therapy, or eye muscle surgery. If detected and treated early, strabismus can often be corrected with excellent results.