Strabismus in babies and children

Strabismus (also called squint) is when your eyes do not point in the same direction at the same time. Strabismus is common in babies and children.

If your child has strabismus, their eyes turn in different directions instead of working together as a team.

You might notice that one or both of your child's eyes point:

• upwards
• downwards
• inwards — called esotropia
• outwards — called exotropia

For your child’s eyes to move together, signals from the brain and the eye muscles need to work well together. If there is a problem with your child’s eye muscles or the signals from their brain, they may develop strabismus.

Strabismus is sometimes wrongly called a ‘lazy eye’. This is not correct — a lazy eye (amblyopia) means reduced vision in one eye and can develop if strabismus is not treated in time.

It is common for a newborn baby’s eyes to not always point in the same direction. This usually improves by the time babies are about 3 to 4 months of age.

Read about eyesight in children.

The main sign of strabismus is that your child’s eyes do not point in the same direction. This may happen all the time, or you may notice it only some of the time.

Your child may also have some of these symptoms:

• double vision
• loss of vision
• loss of depth perception — the ability to see in 3 dimensions and to judge how far away an object is
• dizziness
• nausea

Your child may develop strabismus if there is a problem with how their eye muscles and brain work together to control eye movement.

Strabismus can be congenital, which means that symptoms begin from birth or within the first 6 weeks of life, and symptoms may get worse over time.

Strabismus can also be acquired, which means symptoms develop later in childhood or adulthood.

If your child is born with strabismus, it is usually caused by:

• genetics
• congenital cataracts (a condition that causes clouding of the eye's lens from birth)
• retinoblastoma (a rare eye tumour in children)
• retinopathy of prematurity (when abnormal blood vessels grow in premature babies' eyes)

Acquired strabismus can be caused by injury or certain illnesses.

You should take your child to their doctor if you are worried about their vision, or if they are older than 4 months and their eyes point in different directions.

Your child’s doctor can diagnose strabismus by doing various eye tests that examine their eyes, check their vision and how their eyes move together.

In some cases, your child’s doctor may also refer your child for imaging, for example, a magnetic resonance imaging (MRI) scan.

Read more about medical tests for babies.

Early diagnosis and treatment of strabismus give your child the best chance of good vision.

Strabismus can be treated with surgical and non-surgical options. The aim of treatment is to help your child’s eyes work together and to improve or protect their vision.

Your child’s doctor may first try treating their strabismus with:

• glasses
• eye patches
• eye exercises
• botulinum toxin type A (for example, Botox) injections

How well non-surgical treatments work depends on your child’s condition. Your doctor will help you understand your treatment options and may refer your child to a specialist for further review if needed.

Treatment for severe strabismus

If your child has severe strabismus, their doctor may recommend surgery on their eye muscles. After surgery, your child will need support and therapy to help improve their vision. Their doctor may also recommend vision rehabilitation — a program of guided eye exercises.

Surgical outcomes depend on your child’s age, the severity of their condition and their vision before surgery.

Read about correcting a squint.

Read about helping kids with medical procedures and hospital stays.

If your child has strabismus that is not treated, they can develop long-term vision loss and a ‘lazy eye’ (amblyopia).

These complications can also affect your child’s self-esteem, performance at school and social development, including how they interact with others and feel in everyday situations.

Congenital strabismus cannot be prevented. It is important to diagnose and treat strabismus as early as possible to prevent complications.

You can help your child by having their eyes checked regularly and following any treatment plan if they have strabismus.

The following resources offer more information and support about strabismus and eye health in children:

• Learn more about strabismus on the Children’s Health Queensland website.
• Visit the Sydney Children's Health Network to learn more about common eye problems in children.
• Help prepare your child for an eye test. Watch the Royal Children’s Hospital Melbourne’s video: A child's guide to hospital – Eye Exams.

Information for Aboriginal and/or Torres Strait Islander peoples

Visit a National Aboriginal Community Controlled Health Organisation (NACCHO) to learn about programs that help improve eye and vision health in Aboriginal and Torres Strait Islander communities throughout Australia.

Languages other than English

The Royal Victorian Eye and Ear Hospital has translated fact sheets about eye health into many community languages.