Strabismus (Eye Misalignment) in Children: Symptoms and Treatment
- The Straits Eye Centre
- Sep 19
- 4 min read
Introduction: Understanding Strabismus
Strabismus, commonly known as “squint” or “crossed eyes,” occurs when the eyes do not look in the same direction. While one eye may focus straight ahead, the other may turn inward, outward, upward, or downward.
In children, strabismus is more than just a cosmetic issue. If untreated, it can disrupt visual development, cause double vision, and lead to amblyopia (lazy eye). Early detection and treatment are essential for restoring proper alignment and protecting long-term vision.
What Is Strabismus?
Strabismus is a condition where the eye muscles do not work together to align the eyes. Because the eyes point in different directions, the brain receives two different images. To avoid double vision, the brain may ignore input from the misaligned eye, leading to amblyopia.
Key facts:
Strabismus affects about 2–4% of children.
It may be constant or intermittent.
Early treatment improves outcomes significantly.
Types of Strabismus
Esotropia: Eye turns inward (cross-eyed).
Exotropia: Eye turns outward (wall-eyed).
Hypertropia: Eye turns upward.
Hypotropia: Eye turns downward.
Strabismus may also be constant or appear only when the child is tired or focusing.
Causes of Strabismus
Genetics: Family history increases risk.
Refractive errors: High hyperopia may lead to esotropia.
Muscle or nerve abnormalities: Affecting eye movement.
Associated conditions: Prematurity, cerebral palsy, or Down syndrome.
Symptoms of Strabismus
Children may not always complain of symptoms, but signs to watch for include:
Visible misalignment of one or both eyes.
Squinting or closing one eye, especially in bright sunlight.
Tilting or turning the head.
Complaints of double vision.
Poor depth perception.
Risks of Untreated Strabismus
If not managed, strabismus can lead to:
Amblyopia (Lazy Eye): Permanent vision loss in the misaligned eye.
Poor depth perception: Difficulty judging distances.
Cosmetic and social issues: Affecting self-confidence.
Functional vision problems: Impacting learning, sports, and coordination.
Strabismus in Children: Why Early Care Matters
Strabismus is most effectively treated in childhood when the visual system is still developing. Regular screenings at preschool and primary school help with early detection.
Management in children may include:
Glasses to correct refractive errors.
Patching therapy or atropine drops to strengthen the weaker eye.
Surgery to adjust eye muscles for alignment.
Ongoing monitoring to prevent amblyopia recurrence.
Treatment Options for Strabismus
1. Glasses: Correct refractive errors that may contribute to misalignment.
2. Patching: Covers the stronger eye to stimulate the weaker one.
3. Atropine drops: Temporarily blur the stronger eye to encourage weaker eye use.
4. Surgery: For persistent or significant misalignment, surgery repositions or tightens the eye muscles.
5. Vision therapy: In select cases, exercises may help coordination.
Role of Parents in Strabismus Care
Watch for early signs of misalignment.
Ensure children wear prescribed glasses.
Support compliance with patching or drops.
Encourage follow-up visits for progress checks.
Lifestyle Support and Prevention
While strabismus cannot always be prevented, early detection makes treatment more effective. Parents should:
Arrange regular screenings.
Encourage outdoor play for general eye health.
Seek medical attention if eye misalignment is observed, even intermittently.
Frequently Asked Questions
1. At what age can strabismus appear in children?
It may appear in infancy or later in childhood, often becoming noticeable around preschool age.
2. Is strabismus the same as amblyopia?
No. Strabismus is eye misalignment, while amblyopia is reduced vision due to the brain ignoring one eye’s input. They often occur together.
3. Can strabismus be outgrown?
No. True strabismus requires professional care; it does not resolve without treatment.
4. How is strabismus diagnosed?
Through a comprehensive eye exam that includes checking alignment, vision, and refraction.
5. What is the success rate of strabismus surgery?
Many children achieve improved alignment, but some may need more than one surgery or additional therapies.
6. Can strabismus return after treatment?
Yes, ongoing monitoring is essential as recurrence can happen.
7. Does strabismus always require surgery?
Not always. Mild cases may improve with glasses or patching, but surgery is often needed for significant misalignment.
8. Can strabismus affect adults too?
Yes. Some adults retain strabismus from childhood or develop it later due to trauma, neurological issues, or other conditions.
Meet Our Specialist
At The Straits Eye Centre, your vision care is in the hands of a dedicated team of experienced ophthalmologists. Each of our doctors brings unique expertise and a shared commitment to delivering thorough, patient-focused care for all ages. Whether you need advanced cataract surgery, paediatric eye management, or treatment for complex eye conditions, our team works together to provide the same attentive care we would want for our own families.
Dr Audrey Pang
Consultant Eye Surgeon
Special interest: Paediatric Ophthalmology, Myopia Control, Amblyopia, Strabismus Trained at the University of Cambridge and fellowship-trained in the UK, Dr Audrey Pang specialises in children’s eye care and adult strabismus. She has held roles at Tan Tock Seng Hospital and serves as Visiting Consultant at TTSH and NUH, offering gentle, evidence-based care for patients of all ages.
Cost, Medisave, and Insurance
Many procedures at The Straits Eye Centre are eligible for Medisave claims under MOH guidelines, and certain insurance plans may cover part or all of your treatment costs. Our patient care team will guide you through eligibility, claim limits, and paperwork, so you can focus on your recovery. For more details, refer to our Medisave & Insurance Guide.
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