Crossed eyes : What do I need to know?

Overview

What are Crossed eyes?

Crossed eyes in adults occur when the eyes are not aligned and see in opposite directions. Sometimes people will turn one eye in, out, up, or down while keeping the other fixed straight ahead. The misalignment may originate in one eye and then move to the other.

Both eyes need to be focused on the same object simultaneously in order to see clearly, hence strabismus impairs vision.

Types

Types of Crossed eyes

Strabismus comes in several forms and can affect either children or adults.¹Types| Researched based study from Aoa.org

• Accommodative esotropia
• Intermittent exotropia

Accommodative esotropia

• Most cases of accommodating esotropia can be traced back to untreated hyperopia.
• The mechanism responsible for directing the eye’s gaze is connected to its focusing system.
• Far-sighted people have to strain their eyes more than others to see clearly.
• As a result, the eyes could start to roll inward. Accommodative esotropia can cause double vision, the need to close or cover one eye when reading or doing close work, and other head movements.¹Types| Researched based study from Aoa.org

Intermittent exotropia

• The inability to synchronize the movements of both eyes might lead to the occurrence of intermittent exotropia.
• It’s possible for the eyes to wander away from the subject of gaze. Headaches, reading difficulties, and eye strain are all symptoms that can affect people with intermittent exotropia.
• When observing distant objects or in direct sunlight, they may also shield one eye.¹Types| Researched based study from Aoa.org

Causes

Causes of Crossed eyes

It’s not yet clear what causes crossed eyes. Crossed eyes might be present at birth, whereas in others they appear later in life. It can happen genetically. 2

When crossed eyes are observed, it’s usually because it’s adapting to some kind of visual impairment, like:

• Impairment in distant vision due to short-sightedness.
• Having trouble seeing things up close because of long-sightedness.
• Astigmatism which happens due to an unusual curvature of the cornea, making it difficult to focus on nearby objects.

Some less common causes of crossed eyes are:⁴Causes| Researched based study from Nhs.uk

• Measles and other infectious diseases
• A group of disorders with genetic roots; including Down syndrome
• Slow Development
• Neurological disorders such as cerebral palsy
• Retinoblastoma

Symptoms

Symptoms of Crossed eyes

Strabismus symptoms can be intermittent or persistent. Some possible symptoms are:³Symptoms| Researched based study from Aao.org

• Ocular asymmetry
• Waning eyesight
• Eyes that aren’t focusing on the same thing
• Disorganized eye movement
• Impaired visual or spatial perception
• Cranial rotation to take in one’s surroundings.

Adult-onset strabismus may result also from:

• Botulism
• Acquired paralytic strabismus (induced by diabetes)
• Graves syndrome
• Guillain-Barré syndrome
• Eye damage
• Shellfish poisoning
• Stroke
• Brain damage caused by trauma
• Lack of eyesight due to sickness or injury

If strabismus runs in your family, keep that in mind. One possible reason is farsightedness, which is common among young people. Strabismus can be brought on by any condition that weakens the eyes’ ability to focus.

Consequences

How does Crossed eyes affect eyesight ?

1. When one’s eyes are working together, both focus on the same object. The brain merges the left and right eye’s images into one cohesive 3-D picture. This is how our sense of depth (how far away or close something appears) works.
2. When one eye is misaligned, it sends conflicting signals to the brain. When a child’s eyes aren’t properly aligned, the brain eventually stops paying attention to that image. Instead, it only perceives what the better-sighted or straight-eye sees. Because of this, the kid has trouble judging depth.

Strabismus in adults typically causes double vision. This is due to the fact that their brains have adapted to processing information from both eyes. The image from the turned eye still registers in their brains, causing a double vision effect.³Consequences| Researched based study from Aao.org

Risk factors

Risk factors for Crossed eye syndrome

Genealogical records

• Strabismus is more common in families if a parent or sibling also has the condition. ¹Risk factors| Researched based study from Aoa.org

Perspective distortion

• Due to the extra effort required to maintain good vision, strabismus can occur in people with severe uncorrected farsightedness (hyperopia).

Problems with health

• Strabismus is more likely to occur in people with certain medical problems, such as Down syndrome and cerebral palsy, or when they have experienced a stroke or brain injury.

Complications

Complications of Crossed eyes syndrome

In addition to strabismus, adults may also experience these other disorders:²Complications| Researched based study from Medlineplus.gov

• Apert syndrome
• Cerebral palsy
• Congenital rubella
• Hemangioma close to the eye at the time of infancy
• Incontinentia pigment syndrome
• Noonan syndrome
• Prader-Willi syndrome
• Retinopathy of prematurity
• Retinoblastoma
• Brain injury due to trauma
• Trisomy 18

Diagnosis

Diagnosis of Crossed eyes syndrome

A strabismus diagnosis is made by an optometrist after a thorough examination of the eyes. Strabismus testing may involve observing the eyes’ ability to concentrate and move.¹Diagnosis| Researched based study from Aoa.org

Medical history

• A doctor of optometry may inquire as to the presence or absence of any symptoms.
• The doctor will also take into account any preexisting conditions, drugs, or environmental factors that may be exacerbating the patient’s symptoms.

Visual accuracy

• An optometrist can determine the extent of visual impairment by measuring visual acuity.
• You will be examined on your ability to read both close and far away letters on reading charts.
• One’s ability to see clearly is expressed as a fraction, such as 20/40.
• To view a letter clearly from 40 feet away, someone with 20/40 vision would have to move closer than 20 feet. 20/20 vision is considered “normal” for distance.

Refraction

• The doctor will place a series of lenses called a phoropter in front of your eyes and use a handheld illuminated tool called a retinoscope to measure how the lenses concentrate light.
• Another option is for the doctor to utilize a machine or a hand-held tool to determine the patient’s refractive error.

Checks for attention and alignment

• Your eye doctor will check your eyes’ ability to focus, move, and coordinate with one another.
• In order to see clearly, your eyes must be able to concentrate, move, and coordinate with one another.
• Any issues with your eye’s ability to focus or work together will be checked for during this procedure.

A routine eye checkup

• Your optometrist will examine both your eyes’ internal and external structures, using a battery of tests, to determine the cause of your strabismus and rule out any underlying eye diseases.
• The eyes’ reaction to everyday visual circumstances will be measured by these tests.

Your doctor will be able to tell if you have strabismus based on the results of these tests and any others he or she administers. After diagnostics are finished, you and your doctor can talk about treatment choices.

Treatment

Treatment of Crossed eyes

Strabismus can be treated with corrective lenses, prisms, vision therapy, or even surgery on the eye muscles. Early detection and therapy improve the likelihood of successful strabismus correction. Several methods exist for restoring normal alignment and function to the eyes of strabismus sufferers. Some of them are:¹Treatment| Researched based study from Aoa.org , ²Treatment| Researched based study from Medlineplus.gov ,³Treatment| Researched based study from Aao.org

Wearing corrective lenses or eyeglasses

• For some patients, this may be the only treatment necessary.

Light-focusing lenses made of prisms

• One side of these specialized lenses is thicker than the other. Prisms modify the incoming light and lessen the need to rotate the head to see well. In some cases, using prisms can prevent the eyes from having to move.

Correction of the eyes’ vision via exercises

• Your optometrist may suggest a regimen of visual exercises to help you gain better eye focus and coordination.
• Improved eye-brain coordination can be achieved through vision therapy.
• Strengthening the link between the eyes and the brain, these exercises can aid in correcting issues with eye tracking, focus, and teamwork.
• The optometrist’s office is just one of several possible treatment locations.

Surgical methods

• Most surgical procedures are performed under general or local anesthesia on an outpatient basis in a hospital or ambulatory surgical facility.
• The ophthalmologist creates a tiny incision in the skin around your eye so he or she may access the ocular muscles.
• The eye muscles are realigned such that both eyes gaze in the same direction.
• This procedure may be required in one or both eyes.
• Returning to normal activities is possible within a few days after strabismus surgery.

Injections of botulinum toxin (trade name Botox®)

• An eye muscle injection of this medication is sometimes used to treat strabismus.
• It weakens the eye muscles that prevent the eyes from focusing properly.
• The result may only last a few months, or it may permanently correct your vision.

Prognosis

Prognosis of Crossed eyes

• Eyesight issues may still be present even if the eyes appear to be straight after surgery.
• The child may continue to struggle with reading in class. Adults may have trouble operating motor vehicles. The ability to participate in sports may be compromised by poor eyesight.
• Early detection and intervention typically result in successful resolution of the issue. If treatment is postponed, permanent loss of sight in one eye is possible. Without treatment, amblyopia might become permanent if not caught before age 11.
• Recent studies, however, have shown promise in treating amblyopia with a combination of patching and medication.

Takeaway

Key Takeaway

Strabismus is a condition in which one or both of an individual’s eyes do not look in the same direction. Therefore, they do not gaze in the same direction or at the same things. The opposite eye may be turned in, out, up, or down as the first eye looks straight ahead. One eye may get affected and then the other.

Both eyes need to be focused on the same object simultaneously in order to see clearly, hence strabismus impairs vision. The most prevalent form of strabismus is commonly referred to as “crossed eyes.” Without correcting the strabismus, the eye that is ignored by the brain will never develop normal vision.