<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;"><strong>Contents</strong></span></p>

<p style="text-align: justify;"><em><span style="font-family:arial,helvetica,sans-serif;">Causes</span></em></p>

<p style="text-align: justify;"><em><span style="font-family:arial,helvetica,sans-serif;">Symptoms</span></em></p>

<p style="text-align: justify;"><em><span style="font-family:arial,helvetica,sans-serif;">Exams and Tests</span></em></p>

<p style="text-align: justify;"><em><span style="font-family:arial,helvetica,sans-serif;">Treatment</span></em></p>

<p style="text-align: justify;"><em><span style="font-family:arial,helvetica,sans-serif;">Outlook (Prognosis)</span></em></p>

<p style="text-align: justify;"><em><span style="font-family:arial,helvetica,sans-serif;">When to Contact a Medical Professional</span></em></p>

<p style="text-align: justify;"><em><span style="font-family:arial,helvetica,sans-serif;">Alternative Names</span></em></p>

<p style="text-align: justify;">&nbsp;</p>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;">Strabismus is a disorder in which the two eyes do not line up in the same direction, and therefore do not look at the same object at the same time. The condition is more commonly known as &quot;crossed eyes.&quot;</span></p>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;"><em><img src="https://www.zdrav.kz/images/refs3/ref4.jpg" style="width: 600px; height: 480px;" /></em></span></p>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;"><em>People are very sensitive to other individuals&#39; eye positions. By looking at another person&#39;s eye position, one can very effectively gauge where they are looking. People are also sensitive to eyes that are not looking in the same direction, which is referred to as crossed eyes (strabismus). Other more specific medical terms refer to eyes turned either outward or inward, or that are abnormally rotated. Any appearance of crossed eyes in young children should be immediately evaluated, as should recent onset of crossed eyes in an adult.</em></span></p>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;"><em>People are very sensitive to other individuals&#39; eye positions. By looking at another person&#39;s eye position, one can very effectively gauge where they are looking. People are also sensitive to eyes that are not looking in the same direction, which is referred to as crossed eyes (strabismus). Other more specific medical terms refer to eyes turned either outward or inward, or that are abnormally rotated. Any appearance of crossed eyes in young children should be immediately evaluated, as should recent onset of crossed eyes in an adult.</em></span></p>

<p style="text-align: justify;">&nbsp;</p>

<p style="text-align: justify;">&nbsp;</p>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;"><a id="Causes" name="Causes"><strong>Causes</strong></a></span></p>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;">Six different muscles surround each eye and work &quot;as a team&quot; so that both eyes can focus on the same object.</span></p>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;">In someone with strabismus, these muscles do not work together. As a result, one eye looks at one object, while the other eye turns in a different direction and is focused on another object.</span></p>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;">When this occurs, two different images are sent to the brain -- one from each eye. This confuses the brain. In children, the brain may learn to ignore the image from the weaker eye.</span></p>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;">If the strabismus is not treated, the eye that the brain ignores will never see well. This loss of vision is called amblyopia. Another name for amblyopia is &quot;lazy eye.&quot; Sometimes amblyopia is present first, and it causes strabismus.</span></p>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;">In most children with strabismus, the cause is unknown. In more than half of these cases, the problem is present at or shortly after birth. This is called congenital strabismus.</span></p>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;">Most of the time, the problem has to do with muscle control, and not with muscle strength.</span></p>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;">Other disorders associated with strabismus in children include:</span></p>

<ul>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Apert syndrome</span></p>
	</li>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Cerebral palsy</span></p>
	</li>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Congenital&nbsp;<a href="http://www.zdrav.kz/node/10248">rubella</a></span></p>
	</li>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Hemangioma near the eye during infancy</span></p>
	</li>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Incontinentia pigmenti syndrome</span></p>
	</li>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Noonan syndrome</span></p>
	</li>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Prader-Willi syndrome</span></p>
	</li>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Retinopathy of prematurity</span></p>
	</li>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Retinoblastoma</span></p>
	</li>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Traumatic brain injury</span></p>
	</li>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Trisomy 18</span></p>
	</li>
</ul>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;">Strabismus that develops in adults can be caused by:</span></p>

<ul>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Botulism</span></p>
	</li>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;"><a href="http://www.zdrav.kz/en/node/10011">Diabetes</a>&nbsp;(causes a condition known as acquired paralytic strabismus)</span></p>
	</li>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Guillain-Barre syndrome</span></p>
	</li>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Injury to the eye</span></p>
	</li>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Shellfish poisoning</span></p>
	</li>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;"><a href="http://www.zdrav.kz/en/node/10017">Stroke</a></span></p>
	</li>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Traumatic brain injury</span></p>
	</li>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Vision loss from any eye disease or injury</span></p>
	</li>
</ul>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;">A family history of strabismus is a risk factor. Farsightedness may be a contributing factor, especially in children. Any other disease that causes vision loss may also cause strabismus.</span></p>

<p style="text-align: justify;">&nbsp;</p>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;"><a id="Symptoms" name="Symptoms"><strong>Symptoms</strong></a></span></p>

<ul>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Symptoms of strabismus may be present all the time, or may come and go. Symptoms can include:</span></p>
	</li>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Crossed eyes</span></p>
	</li>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Double vision</span></p>
	</li>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Eyes that do not align in the same direction</span></p>
	</li>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Uncoordinated eye movements (eyes do not move together)</span></p>
	</li>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Vision or depth perception loss</span></p>
	</li>
</ul>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;">It&rsquo;s important to note that because children can develop amblyopia so quickly, they may never have double vision.</span></p>

<p style="text-align: justify;">&nbsp;</p>

<p style="text-align: justify;">&nbsp;</p>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;"><a id="Exams and Tests" name="Exams and Tests"><strong>Exams and Tests</strong></a></span></p>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;">A physical examination will include a detailed examination of the eyes. Tests will be done to determine how much the eyes are out of alignment.</span></p>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;">Eye tests include:</span></p>

<ul>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Corneal light reflex</span></p>
	</li>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Cover/uncover test</span></p>
	</li>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Retinal exam</span></p>
	</li>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Standard ophthalmic exam</span></p>
	</li>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Visual acuity</span></p>
	</li>
</ul>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;">A brain and nervous system (neurological) examination will also be performed.</span></p>

<p style="text-align: justify;">&nbsp;</p>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;"><a id="Treatment" name="Treatment"><strong>Treatment</strong></a></span></p>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;">The first step in treating strabismus in children is to prescribe glasses, if needed.</span></p>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;">Amblyopia or lazy eye must be treated first. A patch is placed over the better eye. This forces the weaker eye to work harder.</span></p>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;">Your child may not like wearing a patch or eyeglasses. A patch forces the child to see through the weaker eye at first. However, it is very important to use the patch or eyeglasses as directed.</span></p>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;">If the eyes still do not move correctly, eye muscle surgery may be needed. Different muscles in the eye will be made stronger or weaker.</span></p>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;">Eye muscle repair surgery does not fix the poor vision of a lazy eye. A child may have to wear glasses after surgery. In general, the younger a child is when the surgery is done, the better the result.</span></p>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;">Adults with mild strabismus that comes and goes may do well with glasses and eye muscle exercises to help keep the eyes straight. More severe forms of adult strabismus will need surgery to straighten the eyes. If strabismus has occurred because of vision loss, the vision loss will need to be corrected before strabismus surgery can be successful.</span></p>

<p style="text-align: justify;">&nbsp;</p>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;"><a id="Outlook (Prognosis)" name="Outlook (Prognosis)"><strong>Outlook (Prognosis)</strong></a></span></p>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;">After surgery, the eyes may look straight but vision problems can remain.</span></p>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;">The child may still have reading problems in school, and for adults driving may be more difficult. Vision may affect the ability to play sports.</span></p>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;">With early diagnosis and treatment, the problem can usually be corrected. Delayed treatment may lead to permanent vision loss in one eye. About one-third of children with strabismus will develop amblyopia.</span></p>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;">Because many children will get strabismus or amblyopia again, they need to be monitored closely.</span></p>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;">When to Contact a Medical Professional</span></p>

<ul>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Strabismus requires prompt medical evaluation. Call for an appointment with your health care provider or eye doctor if your child:</span></p>
	</li>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Appears to be cross-eyed</span></p>
	</li>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Complains of double vision</span></p>
	</li>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Has difficulty seeing</span></p>
	</li>
</ul>

<p style="text-align: justify;">&nbsp;</p>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;"><a id="When to Contact a Medical Professiona" name="When to Contact a Medical Professiona"><strong>When to Contact a Medical Professional</strong></a></span></p>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;">Strabismus requires prompt medical evaluation. Call for an appointment with your health care provider or eye doctor if your child:</span></p>

<ul>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Appears to be cross-eyed</span></p>
	</li>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Complains of double vision</span></p>
	</li>
	<li style="text-align: justify;">
	<p><span style="font-family:arial,helvetica,sans-serif;">Has difficulty seeing</span></p>
	</li>
</ul>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;">Note: Learning difficulties or problems at school can sometimes be due to a child&#39;s inability to see the blackboard or reading material.</span></p>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;"><a id="Alternative Names" name="Alternative Names"><strong>Alternative Names</strong></a></span></p>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;">Crossed eyes; Esotropia; Exotropia; Hypotropia; Hypertropia; Squint; Walleye; Misalignment of the eyes</span></p>

<p style="text-align: justify;">&nbsp;</p>

<p style="text-align: justify;"><span style="font-family:arial,helvetica,sans-serif;"><strong>Source:</strong>&nbsp;<a href="http://www.nlm.nih.gov/medlineplus/ency/article/001004.htm">http://www.nlm.nih.gov/medlineplus/ency/article/001004.htm</a></span></p>
