Crooked Eyes / Pediatric

Two important eye problems usually beginning in childhood are strabismus ("crooked eyes") and amblyopia (a "lazy eye"). Although crooked eyes can be treated with strabismus surgery at any age, early detection and treatment of amblyopia and strabismus help ensure optimal outcomes. For this reason it is recommended that children have their eyes examined by an ophthalmologist (Eye M.D.) no later than age four.


Muscle imbalances in childhood may begin at any time but generally appear before six months of age. As a result of the misalignment, the crooked eye may become lazy or amblyopic. Surgery is necessary to align the eyes. Prior to surgery, any amblyopia present is treated with patching of the good eye. Strabismus in adults is often due to medical problems such as thyroid disease, stroke, tumor, injury or a recurrence of childhood strabismus. Just as with children, eye muscle surgery is used in adults to correct the ocular misalignment. Strabismus surgery is performed by loosening (or recessing) a tight muscle (by setting it farther back on the eye) or by tightening (or resecting) a loose muscle (by removing a section of muscle and reattaching it to the eye). Sometimes both techniques are used together.

Recession Resection
Recession Resection

It may only be necessary to operate on one eye, but in the vast majority of cases surgery is needed on both eyes in order to achieve the best alignment. Surgery is usually performed under general anesthesia on an outpatient basis.

Esotropia, or "crossed eyes" before surgery
Before Strabismus Surgery

Straight eyes following strabismus surgery
After Strabismus Surgery


Amblyopia is poor vision in an eye that did not develop normal sight during early childhood. It is often called a "lazy eye". Usually only one eye is affected by amblyopia. It is a common condition affecting three out of every 100 children. The three major causes are:

  • Strabismus (crooked eyes)
    Misaligned or crossed eyes are the most common cause of amblyopia. The brain "turns off" the crooked eye to avoid double vision and the child uses only the better eye.
  • Unequal focus (refractive error)
    Amblyopia can occur when one eye is more out of focus than the other because it is more nearsighted, farsighted or astigmatic than the fellow eye. The unfocused eye "turns off" and becomes amblyopic or lazy. Although the eye has poor vision it can appear normal. Consequently, this type of amblyopia is the most difficult to detect.
  • Obstructed Vision
    An eye disease such as a cataract (cloudy lens in the eye) or ptosis (a droopy eyelid) may obstruct light from getting into the eye, blocking adequate vision and leading to the development of amblyopia. This is often the severest form of amblyopia.

How is amblyopia treated?
To correct amblyopia, a child must be made to use the weak eye. This is generally accomplished by patching or covering the good eye.

Eye patch worn for amblyopia
Eye Patch

In the case of cataract or ptosis (droopy eyelid), these problems must first be surgically corrected. In the case of unequal focus, glasses are prescribed. Full or part-time patching may be needed for all patients for a period of weeks to months. During this time, periodic checkups will be needed to monitor the level of vision in each eye. Even after vision has been restored in the weak eye, part-time patching may be required over a period of years to maintain improvement.

Extreme farsightedness is also a common cause of crossed eyes (esotropia) in children. This usually begins after age one and is often associated with amblyopia. Treatment is best accomplished with glasses to correct the farsightedness. Amblyopia, if present, is treated with patching. In a few cases, if the eyes do not fully straighten with spectacles alone, it may be necessary to use eye muscle surgery to correct any residual eye misalignment.

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