What is Meant by Crossed Eyes?

Does one of your eyes turn in? Does one of your child’s eyes turn in? Does the eye turn become more apparent when you are tired? Or in the case of your child when he or she is tired? You may have Crossed Eyes.

Crossed Eyes means both eyes can move, but one is out of alignment with the other, like the front wheels of a car. It could be that glasses or eye muscle surgery or both will be necessary to straighten your eyes. Children rarely outgrow this condition.

What are the Causes?

Muscles surrounding the outside of the eyeball (otherwise known as extra-ocular muscles) are responsible for eye movements. In the case of Crossed Eyes, the muscles are not working in synchrony with each other. A particular muscle may be exerting stronger force than the others and so forcing the eye to move in the direction of its force of action or a muscle may be weaker than the others, allowing the other muscles to dominate the eye movement. Crossed Eyes is often associated with Hyperopia (or farsightedness), especially in childhood. Everyone needs to focus their eyes like a camera to do near tasks like reading or working on the computer. A person with Hyperopia needs to focus his or her eyes to see clearly at distance, and then focus even more to see clearly at near.

When the focusing muscles are used, they cause an associated convergence movement of the extraocular muscles to bring the eyes in toward the nose for near viewing. The problem arises if you (or your child) need to focus at distance and even more so at near viewing, and the associated convergence causes Crossed Eyes.

Glasses often can help move the eyes outward by relaxing the need to focus, and thus converge, to see clearly. Some children do outgrow Hyperopia and so the need to wear glasses may decrease with age, but not always.

Now if your Crossed Eyes occur acutely, there are other serious potential causes:

  • Neoplasm (cancer)
  • Head trauma
  • Intracranial Aneurysm
  • Hypertension
  • Diabetes
  • Multiple Sclerosis
  • Myasthenia Gravis
  • Chemotherapy
  • Atherosclerosis
  • Hydrocephalus
  • How are They Diagnosed?

    Routine eye exams are the best way to diagnose this condition. If you notice your young child has an eye turn consulting an eye care provider is your best alternative.

    Early detection is critical in order to reduce the risk of

    Amblyopia. Amblyopia is a condition where there is decreased vision in an eye even with the best correction in place. Common reasons for this include a large difference in eyeglass prescription between the eyes or an eye turn.

    If your child has an eye turn that is constant in one eye and only occurs in that eye, then his or her risk of Amblyopia is greater.

    The eye doctor will measure your child’s refractive state to check for Hyperopia. Also, the degree of eye turn will be measured.

    Your child may complain of double vision, and may even close one eye when doing near work. Thus, his or her visual discomfort will also be taken into account in making the diagnosis.

    These findings will help the eye doctor decide the best course of action to manage your Crossed Eyes.

    How is This Treated and Managed?

    Depending on the cause, your eye care provider will make a decision for treatment based on several factors such as:

  • Your age and when the eye turn began
  • Your overall health
  • Your anticipated compliance with therapy
  • Your symptoms and signs of visual discomfort
  • Your visual demands
  • How much does your eye turn and how often
  • The presence of Amblyopia
  • If the eye turn is significant and especially if discovered early in life, then surgery can be done to the extra-ocular muscles in order to align the eye better.

    The treatment may include any or all of the following options:

  • Glasses to correct Hyperopia and thus can help move the eyes outward by relaxing the need to focus to see clearly.
  • Special lenses called prisms can be put in a glasses prescription to move the image of the object viewed onto or closer to the Fovea of each eye so that you don’t see double images.
  • Vision therapy is analogous to physical therapy. With vision therapy, you are seen by the therapist once per week for a prescribed amount of time (for example, three to six months). The therapist measures your progress and asks you about your symptoms and then gives you vision exercises to do at home to strengthen certain muscles.
  • Extra-ocular Muscle surgery the use of Botulism Toxin injection has been used as an alternative to conventional extra-ocular muscle surgery.
  • If the Crossed Eyes occurred acutely, notify your eye doctor immediately as this could be a sign of a serious condition. Treatment of course would be geared to managing the underlying condition causing the Crossed Eyes, and using either a patch or prism to help you deal with the double vision.


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