Strabismus (crossed eyes) in children

Strabismus, more commonly known to patients as crossed eyes, is a condition where the eyes do not move parallel to each other and are not directed in the same direction when attempting to focus on an object. For example, when one eye looks forward, the other is deviated inward, outward, upward, or downward.

Strabismus is a condition that should not be seen solely as a cosmetic defect, especially in childhood, due to its consequences on children’s vision and neuropsychological development.

The deviation of one eye in a different direction leads to impaired motor development in children—incorrect distance perception, difficulty performing fine motor tasks, challenges in learning sports that require coordination, and delayed learning of reading and writing.

Some types of strabismus cause children to hold their heads tilted in a specific way, leading to muscle imbalance, spinal malformations, and pain.

When treatment is delayed, the period in which binocular and stereo vision can develop is missed, and there is also a risk of developing a lazy eye. Not least, treatment at a later age usually does not allow for the use of non-surgical methods and is associated with less stable and less satisfactory outcomes from surgical methods.

The period up to the age of 8 is extremely critical for a child’s vision—not only for the development of conditions but also for effective and comprehensive treatment. Therefore, we advise parents to include annual eye examinations as part of comprehensive preventative care for every child.

Until when is it normal to see eye misalignment?

In practice, we often hear that a child was not brought to us earlier due to waiting for the condition to resolve on its own or for the child to grow out of it. It is normal to see periodic eye misalignment in newborns until the 3rd or 4th month. A permanent deviation of one eye during this period and after should be monitored in a pediatric eye clinic.

How can we prevent the development of strabismus?

Strabismus in children is, in the majority of cases, congenital or caused by genetic predisposition and is not induced by external factors or daily habits. However, the trend of strabismus emerging in children who use electronic devices from an early age is concerning. Phones and tablets are often in the hands of young children and they easily bring them too close. Their eyes inevitably converge toward the nose to maintain a single image, and due to the high neuroplasticity in children during this period, the incorrect eye position can quickly be ‘coded.’ Excessive screen use at a young age further suppresses neuropsychological development in children, and later, poorly developed cortical functions can also contribute to the occurrence of strabismus.

What are the methods for treating strabismus?

Glasses – in cases where the cause of eye misalignment is a high prescription or a significant difference in refractive error between the two eyes.

Occlusion – covering one eye – this is rarely a standalone method and is usually part of the overall strabismus treatment algorithm. It is important for parents not to initiate eye covering before consulting a doctor, as in many cases of strabismus, this can lead to further disruption of binocular vision.

Exercises – various types of visual therapy exist, which successfully train children to use both eyes simultaneously and support the treatment process.

Surgical treatment – involves the surgical repositioning of the attachment points of the eye muscles to ‘straighten’ the eyes. The procedure is performed on the external muscles that move the eyeball.