What is strabismus?

Strabismus is the medical term used for squint eyes, or crossed-eyes. It is when your eyes do not look in the same direction. There are different types of strabismus. The two most common types are when one or both eyes turn inwards (esotropia) or when they turn outwards (exotropia).

What causes a squint?

Strabismus is either caused by problems to the eye muscles themselves, or with the nerves that supply the eye muscles.  It can also be caused by a refractive error (the need for glasses), or by a lazy eye (amblyopia). It can also just occur in families. These are just the most common causes, there are lots of other reasons why strabismus can occur.

Strabismus can develop at any time, but we do commonly see it in babies or in young children before the age of 3 years. Eyes that are slightly squint before the age of 3 months is usually not anything to be concerned about. It may be due to the fact that the muscles that move the eyes are not fully developed yet and therefore not equally strong, or it could be that the baby’s focus is not fully developed yet. The nose-bridge is also still very flat and the folds next to the nose are very prominent and this causes the eyes to appear squint, even though they are not. This is called pseudo-strabismus.

If you notice that the squint is still present after your child is 4 months old, they will need to be seen by an eye specialist.

What to expect during a consultation?

During the examination I will examine your child’s eye movements and try to establish what their vision is.  I will test to see if they need glasses and will look if there are any signs of a lazy eye.

More than one visit is often needed to establish the extent of the strabismus and to get certainty regarding above mentioned aspects. It may also be necessary to put eye drops in your child’s eye to dilate the pupils in order to test for glasses and to look at the back of the eye for any other problems.  If a proper examination cannot be done in the consulting rooms (normally in younger children), I will arrange to examine your child under anaesthetic (while they are sleeping). This will be done in theatre on a different date.

What is the treatment for crossed eyes?

The treatment is not always straight forward, and differs from child to child. There is not a ‘quick-fix’ solution, therefore be prepared to walk a long road with your ophthalmologist. 

Certain options for treatment includes glasses, and/or surgery to the eye muscles to improve the alignment of the eyes.  More than one operation is often necessary and close follow up afterwards is very important. If a lazy eye is present, occlusion therapy may be needed. This is when the good eye is patched closed so that the lazy eye can learn to see.

If a squint is picked up early, a proper diagnosis is made and optimal treatment is initiated, the prognosis is normally good, and your child can lead a normal, happy life.