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What Causes Strabismus in Babies?

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A baby with strabismus being held by their mother

From the moment they open their eyes, babies use their visual system to learn about their world. The connection between their eyes and their brain undergoes incredible development in the early months of life.

While it’s normal to see one or both eyes wander in the first 4 months of life, baby’s eyes should become aligned between the ages of 4–6 months

If the eyes are not aligned by that time, it’s possible that the child has strabismus, or crossed eyes. Strabismus is a vision problem that can be corrected with vision therapy, a noninvasive treatment option, when it is detected and treated early.

Early detection in an eye exam is essential because strabismus commonly leads to amblyopia (lazy eye), which can in turn cause vision loss if it too is not treated early.

Here’s an introduction to strabismus, vision therapy, and what you can do as a parent to support a lifetime of healthy vision in your child.

What Is Strabismus?

Strabismus is a visual disorder in which the eyes don’t align due to an eye muscle problem. You might also hear it referred to as crossed eyes or eye misalignment.

Crossed eyes are not merely a cosmetic concern, they are a serious vision issue. Left untreated, strabismus can cause double vision and impact depth perception.

How Does Strabismus Affect My Child?

Typically, our brains combine the images from each eye to produce a single clear, 3-D image. 

With strabismus, the eyes are not aligned, so a person sees 2 images instead of one, resulting in blurred vision. Strabismus can also interfere with the normal 3-D view that properly aligned eyes see, which is required for depth perception.

How does this affect your baby? Double vision can make it difficult to understand the images right in front of them. If they see 2 balls being tossed at them, which one do they try to catch?

With reduced depth perception, your baby may struggle to tell where an object is in relation to their body. They may bump into things once they’re crawling and walking, spill a cup of milk they’re reaching for, or misjudge how far away a car is on the road near where they’re playing.

The brain is confused by the mixed messages it’s getting from the misaligned eyes, and it will often turn off, or suppress, the image from the weaker eye. This eye is used less and less by the brain, which can lead to amblyopia or “lazy eye.”

Amblyopia can be prevented and treated, especially when treatment begins early. If it’s not caught and addressed early enough, the brain’s suppression of the weaker eye can lead to considerable vision loss.

Strabismus can be corrected with prescribed vision therapy exercises that are appropriate to a child’s age and development. Treating both strabismus and amblyopia early generally yields the best results. We love to see our littlest patients by age 6 months and again at age 3, as well as any time a parent or caregiver has concerns about a child’s vision.

What Causes Strabismus in Babies?

Strabismus isn’t typically present at birth, but develops between 4–6 months or between ages 2–3 when they start to do more near work, like coloring and drawing.

Strabismus can be caused by a problem with the eye muscles, the nerves that control those muscles, or the part of the brain responsible for eye movements.

Risk factors that might increase the chance of strabismus in your child include:

  • Family history of strabismus or amblyopia
  • Poor vision, including very different refractive errors (being nearsighted or farsighted) in each eye
  • Premature birth
  • Maternal smoking during pregnancy
  • Low birth weight
  • Cerebral palsy, stroke, or brain injury
  • Down Syndrome

Signs of Strabismus in Children

You may have noticed one or both of your baby’s eyes turning in or out occasionally. For many parents, this is the first sign that something might be not quite right. 

Toddlers with strabismus might appear clumsy or uncoordinated, have trouble climbing the stairs, or struggle navigating playground equipment or catching a ball.

In older children, signs of strabismus might be less obvious. Their brain may have compensated by suppressing the image from one eye to avoid them seeing double so the child might not have the same apparent clumsiness from blurred vision. However, you may notice your child turning their head, bringing objects very close to look at them, or squinting, which are all indications they’re not seeing clearly.

A young child wearing glasses with strabismus having their eyes examined during an eye exam.

How Is Strabismus Treated?

Your child’s brain has an incredible ability to change and create new neural pathways. This is called neuroplasticity. The goal of vision therapy is to use this fantastic capacity for adaptation to strengthen the communication between the child’s eyes and brain.

Our vision therapy approach to treating strabismus is a noninvasive, customized, prescribed program of in-office or at-home exercises specific to your child’s visual processing error as well as their development.

In short, it’s an age-appropriate training program for your child’s visual system so they can learn how to see more comfortably and clearly. Vision therapy for strabismus gives your child visual tools they’ll use for the rest of their life. 

Vision Therapy Exercises for Cross-Eyed Babies and Toddlers

For our very littlest patients (toddlers and younger), we’ll generally instruct parents in several at-home vision therapy exercises. We’ll also provide special lenses for the child to wear during the prescribed exercises.

For example, if the child’s eye is turning inward, the parent would move a toy in such a way that the child’s eyes can fixate and follow it as the parent moves it outward. The child would wear glasses with red-green lenses, polarized lenses, or binocular occlusion lenses (which have a semi-translucent blockage of each lens in the area toward the nose).

In technical terms, the goal of vision therapy for strabismus is to strengthen the eye muscles and improve eye coordination, binocular vision, and depth perception. 

Please visit our vision therapy page to learn more about vision therapy exercises for older children.

Glasses for Strabismus

We may prescribe glasses for your child to correct their refractive error as well as align the eyes. Glasses with a prism prescription align the eyes to address double vision.

It can be tough for your child to adjust to wearing glasses for the first time. In your child’s eye exam, we’ll support you with tips to help them get used to their new clearer vision.   

Patching to Correct Amblyopia

If a child’s brain is suppressing the image from their weaker eye, leading to lazy eye (amblyopia), we will typically suggest patching. Patching refers to covering the stronger eye with an adhesive patch for two hours a day so the brain relearns to rely on the weaker eye.

Surgical Solutions for Strabismus

In severe cases of strabismus, when all other treatments have failed, surgery will sometimes be recommended. 

However, we work very diligently with our young patients and their parents to make noninvasive vision therapy as effective as possible in correcting strabismus.

How Is Strabismus Diagnosed in a Baby?

To diagnose strabismus and determine a treatment plan, our doctor will observe your baby’s eyes and may cover and uncover them and watch how they follow a moving object. If your child’s crossed eyes are intermittent, the doctor will assess what situations cause the eyes to turn.  

The doctor will also check for signs of lazy eye at the same time.

When Should I Bring my Child for an Eye Exam?

Eye exams are essential for protecting and preserving your child’s vision as they grow up. 

While we typically want to see babies by 6 months old, we encourage parents to bring infants in earlier if they were born early or have a family history of eye conditions. If anything in your child’s first eye exam requires follow up, we’ll provide you with a personalized schedule for their next appointments. Our eye exams for babies are gentle and friendly, as we want to set them up for many years of positive feelings about the optometrist. Request your child’s appointment today through our booking form.

Written by Dr. David Dalesio

Dr. David Dalesio is an optometrist who has been practicing for over 30 years. He has a doctorate from the New England College of Optometry (Beta Sigma Kappa Optometry Honor Fraternity) and a BA (psychology-biology double major) from the State University of New York at Oswego.

Dr. Dalesio holds a Fellowship in the College of Optometrists in Vision Development (FCOVD) and is renowned in Southwest Florida for his extensive experience in developmental optometry, diagnosing and treating children and adolescents with vision issues. He has been practicing vision therapy for learning-related vision issues for over 20 years.

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