Do You Know All These About Adult Strabismus?

Overview| Categories | Types | Causes | Symptoms | Effects | Diagnosis | Treatment | Prevention | Exercises|

What is adult strabismus?

In simple words, a condition in which the eyes of an individual don’t align up with one another. This means one eye is turned in a direction that is different from the other eye. The movement of the eyes can be in the same or different directions. There can be many types of aligning movements misaligned eyes can have.

  • Both the eyes can be inwards only
  • Both the eyes can be outwards only
  • The direction of one eye is inward but the other is in an outward direction
  • The direction of one eye can be outward but the other eye can be in an inward direction.
  • The direction of one eye is upward and the other eye is in any other direction.
  • The direction of the one eye is downward and the other is in any other direction i.e. upward left wall side and right wall side.

It is also possible that the misalignment of both eyes is in the same direction. But in strabismus, both eyes can’t work together.  

Fact: around 4% (13 million) people in the U.S. have strabismus.

Categories of strabismus:

 it can be categorized into types based on the misalignment of the eyes and where the misalignment is. The categorize are —

  • Turning inward (called esotropia)
  • Turning hypotropia(called exotropia)
  • Turning upward (called hypertropia)
  • Turning downward (called hypertropia

Types of strabismus:

There are several types of strabismus. The prominent ones are as follows —

  • Accommodative esotropia – It occurs in the first few years of life. This occurs in case of uncorrected farsightedness and a genetic predisposition.
  • Intermittent exotropia – This is a condition of hypotropia in which one eye is on the target but the other is pointing outwards. It can occur at any age.
  • Infantile esotropia – This condition mostly occurs within 6 months of birth, in infants. It includes the inward turning of both eyes. Firstly it starts at a random basis but then becomes constant.
  • Ocular misalignment: It mostly found in adults. And can occur due to trauma, stroke, untreated strabismus in childhood, or recurred or progressed from childhood strabismus.

Causes of strabismus:

Our eyes have six muscles to help them in movement. When any type of problem encounters any of these muscles, the alignment and movement of the eyes get affected. This results in the form of strabismus.

Other causes are:

  • Inherited (up to 30% cases)
  • Uncorrected refractive errors
  • Poor vision in one eye
  • Overproduction of thyroid hormone
  • Cerebral palsy
  • Down syndrome
  • Neurological problems
  • Hydrocephalus
  • Head injuries
  • Damage to the nerve responsible for eye movement
  • Damage of that part of the brain which controls eye movement
  • Brain tumors
  • Stroke
  • Refractive error
  • Hypertension
  • Diabetes
  • Tumor in the eye
  • Trauma etc.

Symptoms of strabismus:

  • Misalignment of the eyes
  • Weakness in or around the eyes
  • The feeling of something pulling around your eyes
  • Frequent blinking (especially in bright light)
  • Double vision
  • Blurry vision
  • Inaccurate perception of depth
  • The constant need to tilt your head to see something clearly
  • Eyes that don’t move together etc.

Affects of strabismus:

  • False or inaccurate perception of depth
  • Double vision
  • Low self-esteem
  • Low confidence level
  • Unacceptance by a part of society
  • Difficulty in performing certain tasks which need proper vision etc.

Diagnosis of strabismus:

Anyone having strabismus must opt for a complete diagnosis with a pediatric ophthalmologist. One should also get checked his/her eyes to get the correct examination of how the eyes move and focus. The diagnosis examination may include —

  • Patient’s history – The first thing you need to tell is your medical history and the symptoms you are having at that time. Your family history, general health problems, and regular medication, if any, details can also be asked by your ophthalmologist.
  • Visual acuity – This test involves an activity in which you have to read letters from an eye chart, placed at some distance. Also includes the visual behavior analysis.
  • Refraction – In this, your doctor will check your eyes with a series of corrective lenses to measure how they focus on the lights.
  • Alignment and focus test: This test will help your doctor to know about the difficulty in your vision which are keeping your eyes away from focusing effectively or make it difficult to use both eyes together.
  • Examination of eye health: This involves examination after dilation of your pupils of the eyes, to check the health of the internal eye structure.

By keeping in mind the results your ophthalmologist gets after these and some other tests, your ophthalmologist will prepare and discuss the treatment according to your need.


The result of the treatment also depends on your age and the time when you get diagnosed. Your chances of getting free from strabismus would be as high as early you get diagnosed with strabismus. That means, the later you will do to go for a diagnosis, the less your chances would be to get cured. There are several treatment options available nowadays, your doctor can tell you which treatment plan is suitable for you according to your condition. 

Some of the treatment options are as follows —

  • Vision therapy
  • Eyeglasses or contact lenses
  • Prism lenses
  • Eye muscle surgery
  • Eye exercises

You may get surprised by reading the last option of treatment. But yes, it is true. There are some experts who accept the fact that eye exercises can help to cure strabismus. Here are a few exercises to perform, to get your strabismus treated.

  • Pencil pushups – This is a kind of ‘near point convergence exercises’. Perform this exercise by:

Hold a pencil at one arm’s distance from you and focus your gaze on any of the letters written on your pencil (like brand names’ letters). Now, slowly move the pencil towards the bridge of your no while focusing on it. Keep focusing until your vision gets blurry.

  • Barrel cards – This is the best and easy one for exotropia especially. Draw three barrels of progressive size, lengthwise on one side of a card, one in red. Do the same thing on the other side, in green. Hold the card lengthwise and vertically of your nose such that the largest one is farthest away. Stare both images until they appear as one image and the other two as doubled image. Stare like this for 5 seconds and then shift your gaze to the next one.

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