Strabismus, commonly known as crossed eyes or squint, is a condition in which the eyes do not align properly and point in different directions. When the two eyes cannot fix on the same point, the brain receives two different images. A child's brain resolves this not by seeing double but by suppressing the image from the deviating eye. That is where the real problem begins: the suppressed eye is not used, does not develop, and amblyopia (lazy eye) follows.
For this reason strabismus is not simply a matter of appearance. A deviation may be small enough that parents notice it only in photographs, while vision is quietly being lost behind it. Waiting for a squint to be outgrown is the approach that wastes the most time.
A deviation may be constant, or intermittent and visible only when the child is tired, unwell or daydreaming. Intermittent deviation also needs assessment; it is not a finding to be left to resolve itself.
In infants, a fold of skin at the inner corner of the eye and a broad nasal bridge can make perfectly aligned eyes look crossed. This is pseudostrabismus. The distinction is made by checking whether the corneal light reflex falls symmetrically in both eyes. Pseudostrabismus needs no treatment, but that conclusion should come from an examination rather than from waiting.
The order is almost always the same: vision first, alignment second.
Refractive errors are closely linked to strabismus, so astigmatism in children and myopia in children are worth reading as well. All topics are listed under pediatric eye diseases.
As an Ophthalmologist, Dr. Ayşe Dolar Bilge, I provide diagnosis and treatment services with my experienced team.
Brief, occasional deviations in the first months of life may be normal. Any deviation that persists beyond about four months, or that is constant, needs assessment. Pseudostrabismus caused by a fold of skin at the inner corner requires no treatment, but that distinction should be made by examination rather than by waiting.
No. The operation is performed on the muscles lying on the surface of the eye; the globe is never taken out of the socket. The position and strength of the muscles are adjusted to align the eyes. It is done under general anaesthesia and same-day discharge is usually possible.
Surgery corrects alignment; it does not by itself correct vision. If the deviating eye has become amblyopic, vision is improved by glasses and patching. That is why the sequence is usually to build up vision first and address alignment afterwards.
There is no standard duration: patching hours depend on the child's age and the difference in acuity between the eyes. Vision is measured at each visit and the hours are adjusted. Patching does not straighten the eyes; it develops the vision of the deviating eye, so consistency directly affects the outcome.
Yes, it is the commonest consequence when strabismus is left untreated. To cope with two different images, the child's brain suppresses the one from the deviating eye. The unused eye does not develop and amblyopia sets in. Because the visual pathways are most adaptable in the preschool years, early diagnosis is decisive.
In accommodative esotropia caused by hyperopia, the correct prescription can improve the deviation markedly or resolve it completely, which is why spectacle decisions rest on cycloplegic measurement. When a deviation persists despite glasses, patching and, if needed, surgery come into the plan.
Redness, grittiness, watering and mild swelling are expected in the first days. Redness decreases noticeably within a few weeks, while complete fading takes longer. Swimming pools, the sea and dusty environments are avoided for the period advised, and glasses or patching continue after surgery.
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