Children's Hospital Colorado
Eye Care

Strabismus

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The ophthalmology team at Children’s Hospital Colorado treats strabismus in both children and adults. A person can be born with strabismus or they can acquire it later in life. No matter when you or your child are diagnosed with strabismus, our ophthalmologists have the experience and expertise to provide the absolute best treatment.

What is strabismus?

Strabismus occurs when the eyes are not aligned properly. One or both eyes can be turned inward (crossing or esotropia), outward (drifting or exotropia), upward (hypertropia), downward (hypotropia) or some combination of these. The misalignment can be constant or intermittent, but good vision requires both eyes to point in the same direction, meaning strabismus can affect how well you or your child can see.

Children with strabismus are at risk of developing amblyopia (also called lazy eye), a condition in which the brain does not develop good vision from an eye that is misaligned. Amblyopia is only treatable while the child’s brain is still developing vision and cannot be corrected with glasses or surgery once the patient is past the critical age of development, which occurs from birth to around 8 years old. This is why it’s important to diagnose and treat strabismus and amblyopia from an early age.

Children and adults with strabismus may struggle with depth perception because good three-dimensional vision requires the two eyes working together. Those with strabismus may also experience double vision, or seeing two of things, because of their eye misalignment. Young children with strabismus don’t complain of double vision, because their brain simply ignores the second image. However, adults and older children may experience double vision and also may be self-conscious about the appearance of their eyes.

What causes strabismus?

For the eyes to focus on the same point, all muscles in both eyes must be working together. There are six muscles on each eye, controlled by the long nerves extending from the brain, which must work in coordination.  Strabismus occurs when there is a lack of coordination between the two eyes and the muscles that move them. As a result, the eyes point in different directions and are unable to focus on the same target.

Causes of strabismus in children

Strabismus typically develops in infants and young children but can also occur in older children and adults. There is a higher risk of strabismus in children born prematurely or in children with conditions such as Down syndromecerebral palsycraniosynostosis and hydrocephalus. There is also a higher risk of strabismus in children with a family history.

Other possible causes of strabismus in children include:

  • High farsightedness (hyperopia)
  • Cataracts
  • Eye injury
  • Cranial nerve palsies

Causes of strabismus in adults

Adults can have misaligned eyes that may stem from strabismus they had as a child that has worsened later in life, or it can arise as a new problem later in life. Sudden misalignment or double vision should be evaluated by your primary care provider because it may be caused by vascular or neurologic conditions that could require urgent evaluation and treatment, potentially in the emergency department.

Examples of causes of strabismus in adults include:

  • Prior eye or eye socket surgery, or surgery that affects the brain or nerves that control the eye muscles
  • Trauma (head injuries)
  • Thyroid eye disease (TED), also known as Graves' disease
  • Strokes
  • Poor vision in one eye
  • Nervous system problems, including Parkinson’s, Guillain-Barré syndrome and myasthenia gravis

How common is strabismus?

It’s estimated that up to 4% of the U.S. population has strabismus. In mild cases, you or your child may not be diagnosed until later in life, as the misalignment can worsen with age.

Next steps

  • Would you like to learn more about us?

    Learn more about the Pediatric Ophthalmology department
  • Do you have questions about your child’s condition?

    720-777-2020
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    Schedule an appointment

Get to know our pediatric experts.

Robert Enzenauer, MD

Robert Enzenauer, MD

Ophthalmology

Rebecca Braverman, MD

Rebecca Braverman, MD

Ophthalmology

Emily McCourt, MD

Emily McCourt, MD

Ophthalmology

Jasleen Singh, MD

Jasleen Singh, MD

Ophthalmology

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