Inward, Outward, Up and Down

Strabismus refers to any type of misalignment in the eyes, whether turned inward (esotropia), turned outward (wall-eyed), or one is higher than the other (hypertropia) or lower (hypotropia). It can be obvious or subtle, and may occur occasionally or constantly, in one or both eyes.

Strabismus Causes and Symptoms

Strabismus usually begins in infancy or childhood, though adults can develop it too. While the causes are largely unknown, strabismus seems to develop due to uncoordinated eye muscles that prevent the eyes from moving in tandem. Acquired strabismus can occasionally occur because of a problem in the brain, an injury to the eye socket, or thyroid eye disease.

When young children develop strabismus, they typically have mild symptoms. They may hold their heads to one side if they can use their eyes together in that position. Or, they may close or cover one eye when it deviates, especially at first. Adults, on the other hand, have more symptoms when they develop strabismus. They have double vision and may lose depth perception. At all ages, strabismus is disturbing. Studies show school children with significant strabismus have self-image problems.


Amblyopia, or lazy eye, is closely related to strabismus. Children learn to suppress double vision so effectively that the deviating eye gradually loses vision. It may be necessary to patch the good eye and wear glasses before treating the strabismus. Amblyopia does not occur when alternate eyes deviate, and adults do not develop amblyopia.

If the eyes don't align or move correctly then strabismus surgery may be needed.