Strabismus in children and adults: assessment and treatment
Strabismus is more than appearance. Assessment considers eye alignment, vision in each eye and when the change began.
What does strabismus mean?
Strabismus is a condition in which the eyes do not point in the same direction. An eye can turn inwards, outwards, upwards or downwards; the deviation may be constant or intermittent. It is mainly associated with children but can also occur in adulthood. One photograph is not enough to determine the type or cause, so an observed change warrants professional assessment.
Children also need visual development assessed
When the eyes are misaligned, the brain may ignore the image from one of them. This can impair visual development in that eye and lead to amblyopia, or lazy eye. Strabismus and amblyopia are sometimes related but are not the same condition. Assessing how each eye sees and how they work together separately matters, even if the child does not complain of difficulty.
When to arrange a child's examination
Constant strabismus needs examination, as does strabismus that comes and goes after three months of age. Other signs to describe to the doctor include repeated head tilting, closing one eye when looking or any other concern about vision. There is no need to wait until the child can explain what they see. If the deviation appears only occasionally, a photograph or short video may help show what you noticed.
How to prepare for the appointment
Note when you first noticed the change, whether it is constant and when it is easiest to see. Bring existing glasses and previous examination results if available. Describe any injury or medical change around the time it began. The aim is to give the doctor a clear picture of the problem and its effects on life, rather than arrive with a ready-made diagnosis.
Treatment is not the same for everyone
Options may include glasses, prisms, exercises in certain situations or surgery on the muscles that move the eyes. The choice depends on findings and treatment goals. If amblyopia is also present, it may need separate treatment, such as patching as directed. Do not start patching or an exercise programme found online: what suits one kind of problem may not suit another.
What to ask before surgery
Ask whether the aim is to improve alignment, relieve double vision or achieve another goal. Ask what to expect after surgery, which risks are relevant and what follow-up is needed. Eye alignment surgery does not guarantee full improvement in every visual difficulty, and further treatment is sometimes needed. Expectations should reflect your condition rather than just photographs of other people's results.
New strabismus and double vision need attention
Sudden double vision, or double vision with eye pain, requires urgent assessment. If it is accompanied by a severe headache or a dilated pupil, or began after a head injury, go to an emergency department immediately. New strabismus in adulthood also requires examination rather than an assumption that it is purely cosmetic. Avoid driving while experiencing double vision and seek medical guidance on further activity.
