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Strabismus is a muscular disorder that causes the eyes to misalign. There are four types of strabismus: esotropic, exotropic, hypertropic, and hypotropic. Esotropic is when one eye points inward and exotropic when it points outward. Hypertropic is when one eye points upward and hypotropic when in points downward.

There are also varying degrees of strabismus. One can have large-angle strabismus when the eye is severely in the wrong direction. Small-angle is when the change is less noticeable or is not always apparent. One eye may constantly be putting in the wrong direction, or may only begin to vary when one attempts to move their eyes in a particular direction.

Unilateral strabismus is when the condition only affects one eye and alternating strabismus is when both eyes are affected.

Strabismus commonly presents at a young age and the brain begins to compensate for the deficiency at a very early age. If the strabismus is large-angle, the brain will begin to ignore the signal from that eye. This is what causes amblyopia, or lazy eye. Amblyopia and strabismus are frequently confused for each because they go hand in hand. Additionally, it may work the other way in that amblyopia causes strabismus.

If the strabismus is small angle, the brain may not ignore that eye. Because the eyes are pointing in different directions, it is hard to focus on a single image. This may cause an image to “ghost,” an experience commonly known as double vision. Attempting to focus may cause eyestrain and headaches. When reading, words may appear to jump and you might become fatigued.

If the small-angle strabismus is constant and one experiences it for a long period of time, one may develop amblyopia. In both small and large angles, patients have a lack of normal depth perception.

There are six muscles surrounding the eyeball that allow it to move in all directions. When either these muscles or the nerves connecting to them begin to malfunction, strabismus occurs. It is still not entirely know why this occurs, but many believe that it is a hereditary neurological disorder. Additionally, strabismus can be physically brought about by head trauma or eyestrain. Strabismus can develop is someone excessively attempts to focus their eyes when unable, especially when suffering from extreme refractive errors. This is prevalent among children and is called accommodative esotropia. It can be corrected with glasses.  

Strabismus can be treated through multiple surgeries. The more severe the angle, the more surgeries are needed. If the angle is small enough, physical therapy is the best option. It is impossible to outgrow strabismus. The earlier in life strabismus is treated, the more likely it will not be a problem in the future.