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Causes of Strabismus in Children

Medically reviewed by Victor Paulino, MD, DPBO · Ophthalmology · Makati Medical Center

Written by Lorraine Bunag, R.N. · Updated Aug 03, 2023

Causes of Strabismus in Children

Strabismus is a common condition among children. It affects up to 5% of kids and equally affects boys and girls. What causes strabismus in children, and how can it be corrected?

What is strabismus?  

Before we discuss the causes of strabismus in children, let’s first define the condition.

A child has strabismus if his or her eyes are not aligned. In other words, the eyes are not “looking” in the same direction.

When the eyes are turned inward (esotropia), we commonly refer to this as “duling;” or crossed eyes. On the other hand, when the eyes are turned outwards (exotropia), many use the word “banlag” or wall-eyed. A child also has strabismus if only one eye is misaligned. Furthermore, the eyes can also turn downward or upward.

Possible causes of strabismus in children

You see, 6 eye muscles control how our eyes move. One muscle moves the eye to the right; another moves it to the left. The other 4 muscles turn the eyes upward, downward, and at various angles.

For us to focus on a single point or image, all these muscles must work together.

Strabismus happens when these muscles in one or both eyes fail to work together. However, the exact reason for this failure is still unclear. According to experts, idiopathic strabismus (strabismus of unknown origin) is the most common type of strabismus.

Since the brain controls the eye muscles, the following issues concerning the brain may result in strabismus:

  • Cerebral palsy
  • Hydrocephalus
  • Down syndrome
  • Brain tumor
  • Besides health issues concerning the brain, eye defects may also cause strabismus.

    Factors that increase risk of strabismus

    While the exact causes of strabismus in children are unclear (save for brain and eye concerns), the following factors may increase a child’s risk:

    • Prenatal drug exposure
    • Prematurity or low birth weight
    • Family history of strabismus

    Is strabismus the same as lazy eye (amblyopia)?

    Strabismus and lazy eye are not the same.

    As mentioned earlier, strabismus is a condition with misaligned eyes. On the other hand, amblyopia happens when one of the eyes has a poorer vision, making it weaker or “lazy.”

    However, the two are not unrelated. According to the American Academy of Ophthalmology (AAO), strabismus may lead to amblyopia, with the misaligned eye developing a weaker vision, and hence becoming lazy.

    What are the treatment options for strabismus?

    Experts explain that in normal vision, both our eyes focus on the same spot. Our brain then “coordinates” what the eyes see and forms a single image.

    With strabismus, the eyes are seeing two different images. As a result, the child’s brain may “ignore” the image coming from the weaker or misaligned eye, which affects how they see the position of objects.

    And because strabismus affects vision, treatment is necessary. However, it depends on several factors like what causes the strabismus, your child’s age, and the severity of misalignment.

    Your doctor may recommend the following:

    Wait and observe

    If you observe that your newborn’s eyes are misaligned, don’t panic.

    You see, it’s normal for newborns to have misaligned eyes in the first few months of their life. However, if they remain cross-eyed or wall-eyed past their 4th to 6th month, it may be strabismus. It’s best to bring them to an eye doctor.

    Note that all babies should have a vision screening at age 6 to 12 months. The earlier you detect strabismus, the better.

    Eyeglasses and prisms

    Infants and children may need corrective eyeglasses. The glasses will help them focus and straighten misaligned eyes.

    In some instances, a prism (instrument that bends light) might be attached to the eyeglasses or incorporated as a part of the lens to help the child focus.

    causes of strabismus in children

    Eye patch or eye drops

    Another option is to use an eye patch. In this strategy, the child will wear the patch to cover the better-seeing eye. This forces them to use the misaligned or weaker eye, which may strengthen it over time.

    If an eye patch makes a child uncomfortable, the doctor may give them eye drops that temporarily blur the stronger eye’s vision.

    The doctor will most likely teach the child some eye exercises to improve the misaligned eye’s strength along with eye patch or eye drops.


    And finally, if the above strategies don’t work, the doctor may recommend eye surgery to “reposition” the eye muscles.

    While your child needs general anesthesia for the surgery, they typically don’t need to stay in the hospital overnight and may go home after the operation.

    Learn more about Child Eyecare here. 


    Hello Health Group does not provide medical advice, diagnosis or treatment.

    Medically reviewed by

    Victor Paulino, MD, DPBO

    Ophthalmology · Makati Medical Center

    Written by Lorraine Bunag, R.N. · Updated Aug 03, 2023

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