Strabismus: Understanding Symptoms, Treatment, Causes, Diagnosis, and Prevention

Strabismus is a condition in which both eyes do not look at the same place at the same time, this misalignment creates difficulty for the visual system for tasks such as reading. It has a wide range of causes including poor eye muscle control or muscle damage, nerve damage, differences in prescriptions between eyes, and amblyopia.

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Strabismus: Understanding Symptoms, Treatment, Causes, Diagnosis, and Prevention Optometrist

Strabismus: Understanding Symptoms, Treatment, Causes, Diagnosis, and Prevention Videos

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Don't Suffer in Silence: The Strabismus Symptoms You Need to Know About

Misalignment of the eyes

One eye may turn in, out, up, or down while the other eye is looking straight ahead. This misalignment can be constant or intermittent and can occur in any direction.

Double vision

Strabismus can cause double vision or ghosting of images. This occurs because each eye is seeing a different image, leading to the brain receiving conflicting visual information. Take our online double vision assessment to help identify if you may have an underlying vision problem that is causing diplopia (double vision).

Eye strain and headaches

Prolonged use of the eyes in this misaligned state can cause eye strain, fatigue, and headaches. This is especially true when engaging in activities that require the use of both eyes together, such as reading, watching TV, or playing sports.

Closing or covering one eye

Some individuals with strabismus may have a habit of closing or covering one eye to alleviate double vision and eye strain. This may not be a conscious effort, and the individual may not be aware that they are doing it.

Avoidance of certain activities

Strabismus can also cause individuals to avoid activities that require the use of both eyes together. Examples include reading, driving, playing sports, going places at night that are dark such as dark restaurants, and using a computer or phone. This can lead to decreased visual ability, decreased confidence, and decreased overall quality of life.

Difficulty with depth perception

Strabismus can impair an individual's ability to judge distances, which can make activities such as driving, playing sports, and navigating stairs more difficult.

Reduced visual acuity

The brain may struggle to merge the two conflicting images received from each eye, leading to reduced visual acuity in one or both eyes.

Increased sensitivity to light

Strabismus can cause increased sensitivity to light, making bright environments uncomfortable and even painful.

Poor binocular vision and 3D vision

The misalignment of the eyes can lead to poor binocular vision, making it difficult for the brain to use both eyes together as a team, which in turn can negatively impact 3D vision.

Intermittent double vision

Some individuals with strabismus may experience intermittent double vision, which can be especially disorienting and unsettling.

Poor attention and concentration

Strabismus can cause difficulties with attention and concentration, especially in children who are still developing their visual skills. For example a child with strabismus may find it difficult to read and therefore show signs of inattention or become fidgety in the classroom. 

Increased risk of amblyopia

Also known as "lazy eye," amblyopia can develop in individuals with strabismus as the brain begins to ignore input from the misaligned eye.

If you or a loved one is experiencing any of these symptoms, it is important to seek a comprehensive eye exam from our qualified eye doctor. Early detection and treatment of strabismus can help prevent the onset of more severe visual problems and improve overall quality of life.

Treating Strabismus: Your Options for Improving Vision and Aligning Your Eyes

Treating Strabismus: Your Options for Improving Vision and Aligning Your Eyes

Treatment options for strabismus include:


In some cases, strabismus can be corrected with glasses. This is often the case when the misalignment is caused by a refractive error, such as nearsightedness or farsightedness. Glasses can help correct the underlying visual problem and align the eyes.

Prism Lenses

Prism lenses are special lenses that have a unique shape and are used to correct double vision caused by strabismus. These lenses work by bending light and aligning the two images from each eye into a single, clear image.

Vision Therapy

Vision therapy is a type of therapy for the eyes that helps improve eye alignment, strengthen the eye muscles, and improve visual processing skills. Vision therapy is done in our office under the guidance of a trained vision therapist, with exercises done in between weekly sessions at home. These activities work on different visual skills such as tracking objects, focusing on targets, improving processing speed and accuracy, and practicing eye-hand coordination.

Botox Injection

Botox injections can be used to temporarily weaken the muscles that cause strabismus. This allows the eye muscles to realign and can improve eye alignment. Botox injections typically need to be repeated every few months to maintain the desired effect.


In severe cases, surgery may be recommended to correct the alignment of the eye muscles. There are various surgical options available, including muscle weakening procedures, muscle tightening procedures, and adjustable suture procedures. Surgery is typically performed under general anesthesia and is a highly effective treatment option for strabismus. In many cases surgery for strabismus will be accompanied with vision therapy to reintegrate the visual system after the surgery. 

Treating Strabismus: Your Options for Improving Vision and Aligning Your Eyes

Treating Strabismus: Your Options for Improving Vision and Aligning Your Eyes

It's important to remember that the most effective treatment option will vary from patient to patient and will depend on the underlying cause of the strabismus. You may require a combination of treatments, such as glasses and vision therapy or surgery and vision therapy, to achieve the best results. Additionally, the earlier strabismus is treated, the better the outcome is likely to be. We highly recommend that you schedule an appointment with our functional optometrist to diagnose your condition or get a second opinion about the best treatment option for your strabismus. 

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Understanding the Causes and Risk Factors of Crossed or Misaligned Eyes

Understanding the Causes and Risk Factors of Crossed or Misaligned Eyes

Strabismus, also known as crossed eyes or misaligned eyes, can be caused by various reasons. It is important to be aware of these risk factors in order to take preventative measures and catch strabismus early on. As a local optometry clinic that specializes in neuro optometric rehabilitation and vision therapy, we have seen firsthand the impact that strabismus can have on a person's vision and quality of life, which is why it is crucial to understand the risk factors. Here are some of the most common risk factors for strabismus:

Family history

Strabismus can be hereditary, meaning it can run in families. If you have a family member with strabismus, it is important to be extra vigilant in monitoring your own eye alignment.

Neurological conditions

Certain neurological conditions such as down syndrome, cerebral palsy, multiple sclerosis, and neurofibromatosis can increase the risk of strabismus.

Premature birth

Babies who are born prematurely have a higher risk of developing strabismus, due to the fact that their eyes and brain may not have fully developed at the time of birth.

Refractive error

Refractive error, such as nearsightedness, farsightedness, and astigmatism, can contribute to strabismus. This is because the eyes may be working harder than usual to focus on objects, leading to eye strain and misalignment.


Strabismus is more common in young children and older adults. As we age, our eye muscles can weaken, leading to misalignment.

Ocular and Autoimmune Conditions 

Strabismus can be a result of other ocular conditions such as congenital cataracts, glaucoma, diabetes, dry eye, and retinal detachment. Furthermore autoimmune conditions such as thyroid disease increase the risks of strabismus.  


Injuries can impact the function of the nerves and muscles that control eye movement and cause strabismus. If you have suffered an injury such as a head injury, severe infections, or an injury near the eye and are experiencing visual symptoms, schedule an eye exam today. 

It is important to keep these risk factors in mind and to monitor your eye alignment regularly. If you notice any changes in your vision or eye alignment, it is best to seek the advice of our qualified optometrist as soon as possible. Early intervention is key to managing strabismus and improving vision. Regular eye exams can help detect strabismus early on and allow for prompt treatment.

Diagnosing Strabismus: How Optometrists Assess Eye Misalignment

Strabismus can be diagnosed through a variety of specialized tests, some of those test include:

Visual Acuity Test

This test measures the sharpness of your eyesight. It is performed using a Snellen chart, where you read letters of decreasing size. If one eye has poorer visual acuity than the other, it could indicate strabismus.

Cover Test

This test is used to evaluate the movement of the eyes and their ability to work together. You will be asked to cover one eye at a time while we observe the movement of the other eye. If one eye drifts or moves while the other eye is covered, it is an indication of strabismus.

Hirschberg Test

This test measures the reflection of light in the eyes to determine if they are aligned properly.  We will shine a light at your eyes and observe the reflection to see if the light is centered in both eyes. If the light reflection is off-center in one eye, it could indicate strabismus.

Prism Cover Test

This test uses prisms to measure the extent of misalignment of the eyes. You will be asked to cover one eye while we place a prism in front of the other eye. We then observe the movement of the eye behind the prism to determine the extent of misalignment.

Random Dot Stereogram Test

This test measures depth perception and helps to determine if the eyes are working together. You will be asked to look at a pattern of randomly placed dots and identify any three-dimensional shapes that may appear. If you struggle to identify these shapes, it could indicate strabismus.

Eye Muscle Test

This test evaluates the strength and coordination of the muscles that control the movement of the eyes. We will use a special instrument to apply gentle pressure to the eye and observe the movement of the eye to determine if the muscles are functioning normally.

Case History and Examination

In addition to these tests, a thorough case history and examination of your eyes, including their muscles and nerves, is also important for diagnosing strabismus. We will ask about any symptoms you are experiencing, their medical history, and any previous eye problems.

Treating Strabismus: Your Options for Improving Vision and Aligning Your Eyes
Treating Strabismus: Your Options for Improving Vision and Aligning Your Eyes

Take Our Online Double Vision Quiz

Is blurry, fuzzy, or double vision impacting your quality of life and vision? Take our online double vision assessment to help identify if you may have an underlying vision problem that is causing diplopia (double vision).

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Common Questions

There are several different types of strabismus, including esotropia (eyes turning inward), exotropia (eyes turning outward), hypertropia (one eye turning upward), and hypotropia (one eye turning downward).
There is no known way to definitively prevent strabismus, but early diagnosis and treatment can help minimize the impact of the condition on vision and eye health. Furthermore, preventing eye injuries or complications from certain diseases can reduce the risk of strabismus.
If left untreated, strabismus can lead to permanent vision loss in one eye, decreased depth perception, and difficulties with eye-hand coordination.
Yes, vision therapy can help improve eye alignment, reduce double vision, and improve visual skills in some cases of strabismus.
Strabismus refers to a misalignment of the eyes, while amblyopia (lazy eye) is a condition in which the brain "turns off" the vision in one eye in order to reduce double vision. Strabismus can lead to amblyopia if left untreated.
Yes, botulinum toxin injections can be used to temporarily weaken eye muscles and improve eye alignment in some cases of strabismus.
Strabismus can be improved through treatment, but it may not always be possible to fully cure the condition in all cases.
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Take the First Step to Better Vision: Schedule An Eye Exam For Strabismus

Don't let strabismus affect your daily life anymore. It's time to take control and improve your vision. Schedule an eye exam with us today and discover the benefits of clear, sharp vision. We will provide a comprehensive examination to accurately diagnose and treat your condition. To schedule an eye exam, you can reach out to your nearest Amplify EyeCare practice either via a call or in-person visit. 

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