Strabismus (Eye Alignment)

Name: Strabismus (Eye Alignment)
Brand: Boling Vision Center

Strabismus is a common childhood eye condition in which the eyes don't point in the same direction, and with the right care at the right time, it is very treatable.

When the Eyes Don't Work Together

In healthy binocular vision, both eyes point at the same target simultaneously, allowing the brain to combine their input into a single, clear, three-dimensional image. In strabismus, that alignment breaks down. One eye may turn inward, outward, upward, or downward, either constantly or intermittently, disrupting the brain's ability to merge the two images and putting the child at risk for amblyopia if left unaddressed. At Boling Vision Center's Pediatric Eye Center, we evaluate and treat strabismus with the precision and family-centered care that children deserve. Schedule an evaluation at any of our four Northern Indiana locations if you have concerns about your child's eye alignment.

Understanding Strabismus

Strabismus occurs when the six muscles that control each eye's movement fail to work in precise coordination. That failure can stem from many causes, including problems with the muscles themselves, the nerves that control them, or the brain's ability to coordinate their signals.

The condition affects roughly four percent of children and can present at any age, including in infancy. It may be constant, present all the time, or intermittent, appearing only when the child is tired, sick, or focusing at a particular distance. It's important to understand that strabismus does not resolve on its own. A common misconception is that children will outgrow a turned eye, but without appropriate treatment, the misalignment typically persists, and the risk of amblyopia increases over time.

Types of Strabismus

Strabismus is classified by the direction of the eye turn and the circumstances under which it appears.

Esotropia

Esotropia is the most common form of strabismus in children, in which one or both eyes turn inward toward the nose. Infantile esotropia presents in the first six months of life. Accommodative esotropia, which typically develops between ages two and three, is associated with farsightedness and often responds well to glasses alone.

Exotropia

Exotropia occurs when one or both eyes turn outward away from the nose. It is often intermittent, appearing most noticeably when the child is tired, daydreaming, or looking at distant objects. Intermittent exotropia is one of the most common forms of strabismus seen in children.

Hypertropia and Hypotropia

These forms involve a vertical misalignment, with one eye sitting higher or lower than the other. Vertical strabismus is less common than horizontal forms and may be associated with problems affecting the superior or inferior rectus muscles or the nerves supplying them.

Pseudostrabismus

It's worth noting that not every child who appears to have a turned eye actually does. Wide nasal bridges and prominent epicanthal folds in young children can create the appearance of an inward turn, known as pseudostrabismus, when the eyes are actually aligned normally. A comprehensive eye exam distinguishes true strabismus from pseudostrabismus and provides clarity for concerned families.

The Relationship Between Strabismus and Amblyopia

Strabismus and amblyopia are closely connected, and understanding that relationship is important for appreciating why treatment matters. When the eyes are misaligned, the brain receives two different images from two different directions. To avoid the confusion of double vision, the brain suppresses the image from the turned eye. Over time, that suppression leads to amblyopia: the visual pathways connecting the turned eye to the brain become underdeveloped, and vision in that eye deteriorates. Not every child with strabismus develops amblyopia, but the risk is significant, particularly when the turn is constant rather than intermittent. Treating strabismus early reduces that risk and gives the visual system the best possible chance to develop normally.

Excellent service. Very professional yet personable. I only wish I had found them sooner.

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How Strabismus Is Diagnosed

Diagnosing strabismus requires a comprehensive eye examination that evaluates eye alignment, eye movement, and visual function in each eye individually. At Boling Vision Center, our pediatric eye exams include a thorough assessment of ocular alignment using cover testing, prism measurements, and direct observation of the eyes in multiple positions of gaze.

We evaluate the full range of eye movements and assess for any associated amblyopia or refractive error that may be contributing to or accompanying the misalignment. Our team is experienced in examining children of all ages, including infants and toddlers, using techniques specifically designed for pediatric assessment.

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Treatment Options

Treatment for strabismus depends on the type and severity of the misalignment, the child's age, and whether amblyopia is present. In most cases, a combination of approaches is used.

Corrective Lenses

For children with accommodative esotropia, glasses to correct the underlying farsightedness can reduce or eliminate the eye turn entirely. This is one of the more satisfying results in pediatric eye care: a child's eyes straightening simply from wearing the right prescription. Glasses may also be prescribed to optimize vision in both eyes as part of a broader treatment plan for other forms of strabismus.

Amblyopia Treatment

When amblyopia accompanies strabismus, treating the amblyopia with patching or atropine drops is typically an important part of the overall plan. Improving vision in the weaker eye supports better alignment outcomes and gives the brain stronger input from both eyes to work with.

Vision Therapy

For children with intermittent strabismus, particularly intermittent exotropia, vision therapy exercises can strengthen the brain's ability to maintain alignment and expand the range of conditions under which the eyes work together effectively.

Prism Lenses

Prism lenses incorporated into glasses can compensate for small to moderate degrees of misalignment, reducing symptoms like double vision or eye strain while other treatments are underway or as a long-term management option in appropriate cases.

Strabismus Surgery

When glasses, patching, and other non-surgical approaches are insufficient to achieve adequate alignment, strabismus surgery may be recommended. The procedure adjusts the tension of one or more of the eye muscles to improve alignment, and it is performed at our on-site Joint Commission-certified INSIGHT Surgery Center.

Surgery is typically not the first step, but when it is indicated, it can produce significant, lasting improvements in alignment and the quality of binocular vision. In some cases, more than one surgical procedure is needed to achieve the desired outcome, and glasses or other treatments may still be required afterward.

What to Expect as a Family

A strabismus diagnosis naturally raises questions and concerns. At Boling Vision Center, we take the time to explain the diagnosis thoroughly, walk through the treatment options, and set realistic expectations for the road ahead.

We understand that treatment for strabismus, whether it involves glasses, patching, or surgery, requires commitment from the whole family. Our team provides clear guidance and genuine support throughout the process, and we stay closely engaged through every stage of care.

Why Choose Boling Vision Center?

Boling Vision Center's Pediatric Eye Center brings together the diagnostic expertise, full range of treatment options, and family-centered approach that strabismus care requires. With four Northern Indiana locations, an on-site accredited surgery center, and over 65 years of caring for the families of Michiana, we're equipped to manage strabismus from first diagnosis through every stage of treatment. Amazing happens here.

man getting his eye checked | child getting her eye checked | abstract art

Strabismus (Eye Alignment) Frequently Asked Questions

Will my child outgrow strabismus?

No. Strabismus does not resolve on its own, and waiting to see if a child outgrows a turned eye increases the risk of amblyopia developing in the meantime. Early evaluation and treatment consistently produce the best outcomes.

Is strabismus surgery safe for children?

Strabismus surgery is a well-established procedure with a strong safety record in pediatric patients. As with any surgery, risks exist and are discussed in detail during the consultation. The procedure is performed under general anesthesia, and most children recover quickly with minimal discomfort.

Can strabismus come back after surgery?

In some cases, yes. Strabismus surgery improves alignment significantly, but some children require more than one procedure over time as the eyes continue to develop. Long-term follow-up is an important part of strabismus care regardless of the treatment approach.

My child's eye only turns sometimes. Does that still need treatment?

Intermittent strabismus still warrants evaluation and often treatment, particularly if the turn is becoming more frequent or is associated with symptoms like squinting, covering one eye, or complaints of double vision. The appropriate management depends on the type and frequency of the turn, and your provider will guide that decision based on a thorough assessment.

At what age can strabismus surgery be performed?

Strabismus surgery can be performed at a very young age when indicated, including in infancy for children with infantile esotropia. Earlier alignment often produces better outcomes for binocular vision development, and our team will advise on the optimal timing based on each child's individual situation.