Strabismus: Causes, Symptoms, and Treatment
Written by Achuta Uppu, MD. Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Strabismus?
An ophthalmologist, a medical doctor who treats eye problems and does eye surgery, treats strabismus. Children are often seen by a pediatric ophthalmologist, an eye doctor with special training in children's eyes. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is strabismus?
Strabismus is a disorder in which both eyes do not line up in the same direction. It is also called crossed eyes or a squint. One eye may look straight ahead while the other turns in, out, up, or down.
Each eye has six muscles that control its movement. These muscles must work together so both eyes aim at the same spot. There are three common types. Esotropia is when an eye crosses inward toward the nose. Exotropia is when an eye drifts outward toward the ear. Hypertropia is when one eye points higher than the other.
Symptoms
The most obvious sign is eyes that look out of line. Symptoms can be present all the time or can come and go. They can include:
- crossed eyes or eyes that do not aim in the same direction.
- double vision, which means seeing two images of one thing.
- eyes that do not move together.
- loss of vision or depth perception, which is the ability to tell how near or far something is.
Children may never be aware of double vision. This is because amblyopia can develop quickly. Amblyopia, also called lazy eye, is weaker vision in the eye that is out of line. About one third of children with strabismus develop amblyopia. Adults who develop strabismus after childhood often have double vision.
Causes and who gets it
In most children with strabismus, the cause is unknown. In more than one half of these cases, the problem is present at or shortly after birth. Most of the time, the problem has to do with muscle control, not muscle strength.
In children, strabismus can also be linked to nearsightedness or farsightedness, premature birth, brain-related disorders, Down syndrome, a cataract, or an eye injury. A family history of strabismus raises the chance of having it.
In adults, causes include diabetes, thyroid eye disease, myasthenia gravis, brain tumors, stroke, and head injury. Many adults have had strabismus since childhood.
How doctors diagnose it
An eye doctor does a detailed exam of the eyes. Tests measure how much the eyes are out of line. They include a corneal light reflex test, a cover/uncover test, and a check of visual acuity, which is how sharp your vision is. A brain and nervous system exam is also done.
Treatment
In children, the first step is glasses, if needed. Glasses can fix strabismus in some children whose blurry vision makes their eyes strain.
Next, amblyopia must be treated. A patch is placed over the better eye. This forces the brain to use the weaker eye. Eye drops may also be used to strengthen the weaker eye.
Eye muscle surgery may be needed if the eyes still do not move correctly. The surgeon loosens, tightens, or moves certain eye muscles. Surgery does not replace glasses or patching, and it does not fix the poor vision of a lazy eye. Surgery has risks. They are rare, but they can be serious.
In adults, surgery is the most common treatment. Other options are eye muscle exercises, prism glasses for mild double vision, and Botox injections into the eye muscles.
When to see a doctor
Strabismus should be checked promptly. Contact your provider or an eye doctor if your child looks cross-eyed, says they have double vision, or has trouble seeing. Treatment delays can lead to permanent vision loss in one eye. If amblyopia is not treated by about age 11, it is likely to become permanent.
Call 911 or go to the emergency room if a sudden change in vision comes with sudden dizziness or weakness.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. Either kind of doctor can notice eyes that look out of line and send you to an eye doctor. They can also help keep track of follow-up visits after treatment.
Common questions
Can strabismus go away on its own?
No, a child can outgrow pseudostrabismus, but not strabismus. Pseudostrabismus is when the eyes look crossed but are not. It can happen in children under one year old.
Does strabismus cause lazy eye?
It can. If the eyes are not lined up, amblyopia, or lazy eye, can develop. About one third of children with strabismus develop amblyopia.
Can adults get strabismus?
Yes, adults can get strabismus. Many adults have had it since they were children, but sometimes it starts later in life. In adults, it can follow conditions such as diabetes or a stroke.
Is surgery the only treatment for strabismus?
No, surgery is not the only treatment. Some children are treated with glasses, patching, or eye drops. Adults may use prism glasses or Botox injections, and some need surgery.
Does eye muscle surgery fix lazy eye?
No, eye muscle repair surgery does not fix the poor vision of a lazy eye. Amblyopia must be treated, or surgery will fail to improve vision.
Sources
- MedlinePlus - Strabismus
- American Academy of Ophthalmology - Strabismus in Children
- American Academy of Ophthalmology - What Is Adult Strabismus?
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
