What is Crossed Eyes or Strabismus?

Crossed eyes or medically known as strabismus occurs when eyes are not aligned with each other. The brain is unable to coordinate eyes to work together. Strabismus can be categorized into four groups by the direction of the eye misalignment, namely esotropia (inward turning), exotropia (outward turning), hypertropia (upward turning) and hypotropia (downward turning).

How Common is Strabismus or Crossed Eyes?

Strabismus affects between 2-4% of the population.

Symptoms of Strabismus

In general, symptoms include eye misalignment, squinting or closing eyes in bright sunlight, tilting or turning the head, bumping into things because of limited depth perception, double vision, and headaches.

Double vision, closing or covering one eye when gazing at something close, and tilting or moving the head are all symptoms of Accommodative esotropia. For Intermittent exotropia, double vision, headaches, difficulties reading, eyestrain, and closing one eye when seeing far distant objects or in strong light are all possible symptoms. Patients may experience no symptoms, but others may perceive the ocular deviation.

Causes of Strabismus

Normally, children do not realize any changes in their vision if they have strabismus. However, some complain about double vision or just general issues with seeing objects. Strabismus can be present at birth or develop during childhood. The majority of strabismus is caused by abnormality of the neuromuscular control of eye movement which is the consequence of medical conditions, such as Down Syndrome and cerebral palsy. Furthermore, strabismus can be genetically related and run in the family.

Types of Strabismus

There are several types of strabismus, but two most common forms are Accommodative esotropia and Intermittent exotropia. Accommodative esotropia arises when a person has uncorrected farsightedness and a genetic predisposition for their eyes to turn inward. This type of strabismus usually develops throughout the first few years of a child’s life. Intermittent exotropia refers to focusing with one eye on an object while the other eye is gazing outward. Intermittent exotropia happens at any age. 



The majority of children with strabismus are identified between the ages of one and four. After the age of six, a kid may also get strabismus. If this occurs, the child should consult a doctor right away to rule out any other conditions. If one or both eyes wander in, out, up, or down on a regular basis, it’s most probably due to strabismus. The examination may include a range of activities from patient’s history, visual acuity, refraction, alignment and focus testing. 

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1. Eyeglasses or contact lenses: In some forms of strabismus, eyeglasses or contact lenses may be the only treatment that is needed to correct misalignment.

2. Prism lenses: However, in other cases, other treatment approaches are needed such as prism lenses, vision therapy or eye muscle surgery. Prism lenses are lenses that are thicker on one side than the other. The prisms change the way light enters the eye, reducing the amount of turning required to perceive objects. The prisms can sometimes obviate the need to turn your head.

3. Vision therapy: Vision therapy is a type of therapy that involves structured programs including exercises that teach the eyes and brain to work together more efficiently. Exercises aid with eye movement, concentrating, and teaming, as well as strengthening the eye-brain relationship. Treatment can take place both in the office of your optometrist and at home.


AmblyoPlay is a vision therapy performed with a combination of anaglyph (red and green filter) glasses. In the last decades, active lazy eye training methods are gaining ground. Using different exercises and activities, we can improve the lazy eye and train the visual system to develop a healthy vision. In cases of strabismus, AmblyoPlay is efficient for exotropia (outward) or esotropia (inward) form of deviation.

Vision therapy is performed through playing therapeutic games and exercises on your tablet or computer. What is more, the use of red and green lenses allows excellent control over stimulus characteristics. When a red filter is placed over the right eye and a blue filter is placed over the left eye, the right eye sees only red targets and the left eye sees only blue targets, allowing you to see with both eyes at the same time.

Researchers found hat treatments that include fun activities have a higher percentage of compliance. As games are very engaging, a greater compliance is achieved. Therapy programs with a high degree of compliance have relatively large treatment effects.

4. Eye muscle surgery: Eye muscle surgery alters the length of muscles and corrects misalignment of the eyes. Prior to surgery, it is most important to rehabilitate any vision loss from amblyopia. After eye muscle surgery, vision therapy is often required to improve eye coordination and prevent the eyes from becoming misaligned again.


    Adults disorders that cause strabismus include Trauma, neurological problems, Graves disease, Diabetes, Stroke, Tumor and other. Generally speaking, adults with strabismus will have symptom of double vision. Adults may possess misalignment as a result of residual childhood strabismus or as a result of adults-onset strabismus. Strabismus in adults can be treated. The most qualified specialist to treat adults with misaligned eyes is an ophthalmologist who specializes in strabismus. Other specialists can be used to figure out what’s causing the misalignment.

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