Eye Misalignment (Strabismus): Causes and Treatment Options
Eyes that do not point in exactly the same direction, whether that shows up as a noticeable turn or a subtle drift that only appears occasionally, describe a condition called strabismus. Many people associate this exclusively with young children, but strabismus can develop or persist well into adulthood, and it presents quite differently depending on when it starts.
At St. George Eye Center, strabismus care spans both pediatric and adult patients, reflecting the full range of comprehensive eye care our practice provides beyond the surgical procedures we are perhaps best known for. This guide explains what strabismus is, how it looks different in children compared to adults, and the treatment options available at each stage.
What Is Strabismus?
Strabismus refers to a misalignment of the eyes, where one eye points in a different direction than the other. This can involve one eye turning inward, outward, upward, or downward relative to the other, and it may be constant or intermittent, appearing only under certain conditions like fatigue or when focusing on a specific distance.
The condition results from a problem with the coordination between the eyes, the muscles that control eye movement, or the neurological signals directing them. Several distinct underlying causes can contribute, and identifying the specific cause plays a significant role in determining the right treatment approach.
Strabismus in Children
In children, strabismus is relatively common and often first noticed by a parent or caregiver, sometimes as early as infancy. Early identification matters considerably here for a specific reason: a young, developing visual system can adapt to misalignment in ways that create lasting consequences if left untreated.
Amblyopia risk. When one eye is misaligned, the brain may begin to favor the stronger, better-aligned eye and effectively ignore input from the misaligned one. Over time, this can lead to amblyopia, commonly known as lazy eye, where the ignored eye's vision fails to develop normally. This is why timely treatment during childhood is so important, since the visual system's ability to adapt and improve is much greater at a young age than later in life.
Common causes in children. Strabismus in children can result from issues with the eye muscles themselves, problems with the nerves controlling those muscles, a significant difference in refractive error between the two eyes, or in some cases, an underlying neurological or developmental condition.
Why early evaluation matters. A pediatric eye exam can identify strabismus and any related amblyopia early, when treatment has the greatest chance of restoring normal visual development in both eyes.
Strabismus in Adults
Adult strabismus presents a different picture. In some cases, it represents a childhood condition that was never fully treated and has persisted or changed over time. In others, it develops newly in adulthood due to a separate underlying cause.
New-onset causes in adults. Adult-onset strabismus can result from nerve damage, certain neurological conditions, thyroid eye disease, diabetes affecting the nerves controlling eye movement, or trauma to the eye or surrounding structures. Because new strabismus in an adult can sometimes signal an underlying medical condition, an eye misalignment that appears suddenly deserves a prompt evaluation.
Double vision as a common symptom. Unlike children, whose developing brains often adapt to misalignment by suppressing input from one eye, adults are far more likely to experience double vision when strabismus develops, since the adult visual system does not adapt in the same way.
Impact on daily life. Adult strabismus can affect depth perception, create difficulty with tasks like driving, and in some cases lead to self-consciousness about the visible eye misalignment itself, all of which are legitimate reasons to pursue evaluation and treatment.
Key takeaway: Childhood strabismus carries a specific risk of amblyopia and permanent vision impact if untreated, while adult strabismus more often causes double vision and can signal an underlying medical condition that deserves its own evaluation.
Treatment Options
Treatment for strabismus depends on the underlying cause, the patient's age, and the specific pattern of misalignment.
Corrective glasses. In some cases, particularly when strabismus is related to uncorrected refractive error, properly prescribed glasses can improve or fully correct the alignment.
Vision therapy. Certain types of strabismus, particularly those related to eye coordination and focusing, may improve with structured vision therapy exercises designed to strengthen the connection between the eyes.
Patching or other amblyopia treatment. For children at risk of or already experiencing amblyopia, patching the stronger eye encourages the brain to use and strengthen the weaker eye, supporting more balanced visual development.
Prism lenses. Special prism lenses can help redirect light to compensate for certain types of misalignment, which is particularly useful for adults experiencing double vision.
Eye muscle surgery. For more significant or persistent misalignment, surgery to adjust the eye muscles can correct alignment directly. This is a well-established procedure used in both children and adults, with the specific approach tailored to the type and severity of the misalignment.
Addressing an underlying condition. When adult strabismus stems from a separate medical issue, such as thyroid eye disease or a neurological condition, treating that underlying cause is an important part of managing the eye misalignment itself.
A Comprehensive Approach to Eye Care
Strabismus care illustrates something important about what a full-service ophthalmology practice actually offers. While cataract surgery and LASIK are often the most visible parts of our practice, comprehensive eye care extends well beyond those procedures, covering conditions that affect patients at every stage of life, from a toddler's first eye exam through complex adult eye health concerns.
Dr. Jason Hendrix, among our doctors, specializes in pediatric eye conditions, including amblyopia and strabismus management, alongside his broader work in comprehensive ophthalmology, cataract surgery, and refractive surgery. This combination allows our practice to care for an entire family's eye health under one roof, from a child's developing vision to an adult's more complex eye care needs.
Schedule an Evaluation for Eye Misalignment
Whether you have noticed a misalignment in your child's eyes or are experiencing new double vision as an adult, a proper evaluation is the right first step. Visit St. George Eye Center to learn more about our full range of services, or contact us to schedule an evaluation with a doctor experienced in diagnosing and treating strabismus at any age.
