When the Eyes Are Not Looking in the Same Direction
Strabismus, often referred to as a squint, is a condition where the eyes do not point in the same direction. One eye may look straight ahead while the other turns inward, outward, upward, or downward. It can be constant or may come and go.
At London Eye & Retina, we understand how concerning it can be for parents to notice a misalignment in their child’s eyes. The good news is that with early diagnosis and the right care plan, many children can achieve good vision and proper eye alignment.
What Is Strabismus?
Strabismus occurs when the eye muscles do not work together in a coordinated way, leading to misaligned eyes. One eye may be dominant, while the other deviates.
This misalignment can interfere with normal visual development, depth perception, and may lead to amblyopia (lazy eye) if untreated. Strabismus can also affect self-esteem as children become more socially aware.
Types of Strabismus
There are several types, depending on the direction of eye deviation:
- Esotropia – inward turning of the eye
- Exotropia – outward turning of the eye
- Hypertropia – upward deviation
- Hypotropia – downward deviation
Strabismus may be congenital (present at birth), accommodative (related to focusing effort), or intermittent (occurs only occasionally).
What Causes It?
Strabismus can result from various factors, including:
- Imbalance in the eye muscles
- Significant refractive errors (e.g. long-sightedness)
- Neurological conditions or developmental delays
- Family history of strabismus
- Trauma or eye injuries
In many cases, there is no identifiable cause, but early evaluation remains important to prevent long-term complications.
What Are the Symptoms?
In young children, parents or caregivers may notice:
- Eyes that do not move together
- One eye turning inward or outward
- Squinting or tilting the head to look at objects
- Frequent eye rubbing
- Complaints of double vision (in older children)
- Difficulty with depth perception
- A tendency to close one eye in bright light or when focusing
Sometimes, strabismus is only noticeable when the child is tired or unwell, which is why regular screening is recommended.
How Is It Diagnosed?
At London Eye & Retina, we offer detailed eye alignment assessments tailored for children. Diagnosis may include:
- Visual acuity testing for each eye
- Refraction to assess the need for glasses
- Ocular motility testing to evaluate eye muscle movement
- Cover tests to detect latent or subtle strabismus
- Fundus examination to ensure normal retinal structure
In infants and toddlers, we use age-appropriate tools and observation techniques to make the process comfortable and accurate.
How Is Strabismus Treated?
Treatment aims to improve eye alignment, restore binocular vision, and prevent amblyopia. Options may include:
- Prescription glasses to correct underlying refractive errors
- Patching therapy if amblyopia is present
- Eye exercises (orthoptics) for certain cases
- Botulinum toxin injection for temporary muscle adjustment
- Strabismus surgery to realign the eye muscles (in selected cases)
Our approach is individualised, based on the type of strabismus, age of the child, and how the eyes respond to non-surgical treatments.
Why Early Treatment Matters
Strabismus is more than a cosmetic concern. If left untreated, it can lead to reduced vision in one eye, poor depth perception, and difficulty with reading or hand-eye coordination later in life.
Early diagnosis, especially in the preschool years, offers the best chance for full visual development and better long-term outcomes.
Let’s Straighten Things Out, Together
If you notice that your child’s eyes appear misaligned, even occasionally, don’t wait for it to “correct itself.” A squint can affect more than appearance, it can impact your child’s visual future.
Book a paediatric eye consultation at London Eye & Retina for a comprehensive assessment and care plan.
Early Support for Better Visual Development
