Strabismus

Treatment Overview

Treatment for strabismus should begin as soon after diagnosis as possible. In general, the younger the child is when treatment for strabismus begins, the better the chances are of correcting the problem.

Treatment should also address amblyopia (lazy eye) or other vision problems to help normal vision to develop. If amblyopia has developed, aligning the eyes will not reverse it.

Early treatment is important to correct strabismus, but time is even more critical with amblyopia. Amblyopia can damage a child's vision quickly and permanently. After about age 7 to 10 years, no treatment can completely correct poor vision caused by amblyopia. For more information, see the topic Amblyopia.

Treatment for strabismus may include glasses, patches, drug treatments, eye exercises, botulinum toxin, or surgery.

Glasses

If the eyes are only slightly misaligned, wearing glasses can sometimes correct strabismus. Some children may need to wear bifocals or special lenses called prisms. Along with wearing glasses, they may need to use eyedrops for a while.

Eye patches

This is primarily a treatment for amblyopia (lazy eye), which may be either the result of strabismus or its cause. The stronger eye is covered with a patch to force the child to use the weaker eye. It is important to carefully follow instructions for wearing an eye patch and to not have a child wear a patch longer than your doctor recommends because excessive use of a patch can cause amblyopia in the initially stronger eye. For more information on wearing an eye patch, see:

Amblyopia: Wearing an eye patch.

Drug treatments

The doctor may prescribe certain drugs, usually in the form of eyedrops, as part of the treatment. Atropine and miotics (such as echothiophate iodide) affect muscles in the eye that control the pupil and the eye's ability to focus. Miotics may be used when strabismus is caused by problems in focusing the eyes. Atropine is sometimes used as an alternative to patching to help treat poor vision (amblyopia) in one eye by blurring the vision in the good eye beyond that of the weaker eye and forcing the child to use the weaker eye.

Eye exercises

Exercises may occasionally be used in addition to other treatments, such as surgery. But eye exercises alone are not helpful in most cases of strabismus.

Botulinum toxin

Botulinum toxin (such as Botox) is a drug that temporarily prevents contraction of a muscle for several months at a time. This causes the muscle to relax, which allows the opposing muscle to change the eye's position. It is sometimes used as a supplemental treatment when surgery does not entirely correct the misalignment of the eyes. It is a controversial treatment, however, because it may require many injections, results are not always predictable, and it may create other vision problems and simply delay further surgery.

Surgery

Surgery is often the only way to align the eyes and improve vision in children who have strabismus. During surgery, the doctor loosens or tightens the muscles around the eye by changing their length or position. Altering the pull of the muscles can bring the eyes back into line with each other. A child may need more than one surgery to realign the eyes and improve vision and may have to wear or continue wearing glasses after the surgery.

Because early treatment is important to correct strabismus, surgery in children younger than age 2 is not unusual, and it can be performed as early as 3 months of age in serious cases, particularly if the strabismus is detected early. But the effectiveness of surgery in children younger than 6 months is controversial because, although rare, strabismus in very young children sometimes disappears on its own as development continues.²

Surgery in adults to correct strabismus, although not as common as in children, is a safe and effective way to improve alignment of the eyes. Surgery in an adult can improve vision and depth perception, relieve double vision, broaden the visual field when the eyes are turned inward, or reduce the visual field when eyes are turned outward. Having surgery can also improve self-esteem and the ability to communicate with others.³

See a picture of how strabismus is corrected with surgery.

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Author:	Ralph Poore	Last Updated: April 16, 2007
Medical Review:	Michael J. Sexton, MD - Pediatrics Ian MacDonald, MDCM, FRCSC - Ophthalmology
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