Highlights & Basics
- Strabismus is a condition where there is misalignment of the visual axes of the eyes; it may be latent or manifest and, if manifest, it may be constant or intermittent.
- It is a common cause of diplopia and visual confusion (seeing different objects in the same place) in adults.
- It is an important cause of amblyopia (decreased vision in an anatomically normal eye caused by suppression) in children.
- It may be esthetically obvious to the patient and others, resulting in psychosocial problems.
- Evaluation involves a detailed medical history, including a complete ocular history, followed by thorough neurologic and ophthalmic examinations.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Citations
US Preventive Services Task Force. Vision in children ages 6 months to 5 years: screening. Sep 2017 [internet publication].[Full Text]
Sprunger DT, Lambert SR, Hercinovic A, et al. Esotropia and exotropia preferred practice pattern®. Ophthalmology. 2023 Mar;130(3):P179-221.[Abstract][Full Text]
Hutchinson AK, Morse CL, Hercinovic A, et al. Pediatric eye evaluations preferred practice pattern. Ophthalmology. 2023 Mar;130(3):P222-70.[Abstract][Full Text]
Dagi LR, Velez FG, Holmes JM, et al. Adult strabismus preferred practice pattern®. Ophthalmology. 2024 Apr;131(4):P306-403.[Full Text]
Cruz OA, Repka MX, Hercinovic A, et al. Amblyopia preferred practice pattern. Ophthalmology. 2023 Mar;130(3):P136-78.[Abstract][Full Text]
1. US Preventive Services Task Force. Vision in children ages 6 months to 5 years: screening. Sep 2017 [internet publication].[Full Text]
2. Sprunger DT, Lambert SR, Hercinovic A, et al. Esotropia and exotropia preferred practice pattern®. Ophthalmology. 2023 Mar;130(3):P179-221.[Abstract][Full Text]
3. Govindan M, Mohney BG, Diehl NN, et al. Incidence and types of childhood exotropia: a population-based study. Ophthalmology. 2005 Jan;112(1):104-8.[Abstract]
4. Greenberg AE, Mohney BG, Diehl NN, et al. Incidence and types of childhood esotropia: a population-based study. Ophthalmology. 2007 Jan;114(1):170-4.[Abstract]
5. Tollefson MM, Mohney BG, Diehl NN, et al. Incidence and types of childhood hypertropia: a population-based study. Ophthalmology. 2006 Jul;113(7):1142-5.[Abstract]
6. Yu CB, Fan DS, Wong VW, et al. Changing patterns of strabismus: a decade of experience in Hong Kong. Br J Ophthalmol. 2002 Aug;86(8):854-6.[Abstract][Full Text]
7. van Splunder J, Stilma JS, Bernsen RM, et al. Prevalence of ocular diagnoses found on screening 1539 adults with intellectual disabilities. Ophthalmology. 2004 Aug;111(8):1457-63.[Abstract]
8. O'Connor AR, Stephenson T, Johnson A, et al. Long-term ophthalmic outcome of low birth weight children with and without retinopathy of prematurity. Pediatrics. 2002 Jan;109(1):12-8.[Abstract]
9. Mohney BG. Common forms of childhood strabismus in an incidence cohort. Am J Ophthalmol. 2007 Sep;144(3):465-7.[Abstract]
10. Matsuo T, Matsuo C. The prevalence of strabismus and amblyopia in Japanese elementary school children. Ophthalmic Epidemiol. 2005 Feb;12(1):31-6.[Abstract]
11. Çorak Eroğlu F, Oto S, Şahin Fİ, et al. The role of heredity and the prevalence of strabismus in families with accommodative, partial accommodative, and infantile esotropia. Turk J Ophthalmol. 2020 Jun 27;50(3):143-50.[Abstract][Full Text]
12. Ye XC, Pegado V, Patel MS, et al. Strabismus genetics across a spectrum of eye misalignment disorders. Clin Genet. 2014 Aug;86(2):103-11.[Abstract][Full Text]
13. Paul TO, Hardage LK. The heritability of strabismus. Ophthalmic Genet. 1994 Mar;15(1):1-18.[Abstract]
14. Maconachie GD, Gottlob I, McLean RJ. Risk factors and genetics in common comitant strabismus: a systematic review of the literature. JAMA Ophthalmol. 2013 Sep;131(9):1179-86.[Abstract][Full Text]
15. Kok JH, Prick L, Merckel E, et al. Visual function at 11 years of age in preterm-born children with and without fetal brain sparing. Pediatrics. 2007 Jun;119(6):e1342-50.[Abstract]
16. Holmstrom G, el Azazi M, Kugelberg U. Ophthalmological follow up of preterm infants: a population based, prospective study of visual acuity and strabismus. Br J Ophthalmol. 1999 Feb;83(2):143-50.[Abstract][Full Text]
17. American College of Radiology. ACR appropriateness criteria: orbits, vision and visual loss [internet publication].[Full Text]
18. American Academy of Ophthalmology. Adult strabismus summary benchmarks 2024. Dec 2024 [internet publication].[Full Text]
19. American Academy of Ophthalmology. Pediatric ophthalmology/strabismus summary benchmarks - 2024. Dec 2024 [internet publication].[Full Text]
20. Donahue SP, Baker CN, Committee on Practice and Ambulatory Medicine, American Academy of Pediatrics, et al. Procedures for the evaluation of the visual system by pediatricians. Pediatrics. 2016 Jan;137(1):e20153597.[Abstract][Full Text]
21. Jacobs DS, Afshari NA, Bishop RJ, et al. Refractive errors preferred practice pattern®. Ophthalmology. 2023 Mar;130(3):P1-60.[Abstract][Full Text]
22. Taylor K, Elliott S. Interventions for strabismic amblyopia. Cochrane Database Syst Rev. 2014 Jul 23;(7):CD006461.[Abstract][Full Text]
23. Gov.UK (National Screening Committee). Child screening programme: vision defects. Aug 2019 [internet publication].[Full Text]
24. Public Health England. Child vision screening. Apr 2019 [internet publication].[Full Text]
25. Hutchinson AK, Morse CL, Hercinovic A, et al. Pediatric eye evaluations preferred practice pattern. Ophthalmology. 2023 Mar;130(3):P222-70.[Abstract][Full Text]
26. American Academy of Ophthalmology. Vision Screening for Infants and Children - 2022. Oct 2022 [internet publication].[Full Text]
27. American Academy of Ophthalmology. Referral of persons with possible eye diseases or injury - 2014. Apr 2014 [internet publication].[Full Text]
28. Dagi LR, Velez FG, Holmes JM, et al. Adult strabismus preferred practice pattern®. Ophthalmology. 2024 Apr;131(4):P306-403.[Full Text]
29. Cruz OA, Repka MX, Hercinovic A, et al. Amblyopia preferred practice pattern. Ophthalmology. 2023 Mar;130(3):P136-78.[Abstract][Full Text]
30. Weakley DR Jr, Holland DR. Effect of ongoing treatment of amblyopia on surgical outcome in esotropia. J Pediatr Ophthalmol Strabismus. 1997 Sep-Oct;34(5):275-8.[Abstract]
31. Pang Y, Gnanaraj L, Gayleard J, et al. Interventions for intermittent exotropia. Cochrane Database Syst Rev. 2021 Sep 13;(9):CD003737.[Abstract][Full Text]
32. Piano M, O'Connor AR. Conservative management of intermittent distance exotropia: a review. Am Orthopt J. 2011;61:103-16.[Abstract]
33. Barrett BT. A critical evaluation of the evidence supporting the practice of behavioural vision therapy. Ophthalmic Physiol Opt. 2009 Jan;29(1):4-25.[Abstract]
34. The Royal College of Ophthalmologists. Strabismus surgery for adults in the United Kingdom: indications, evidence base and benefits. Aug 2017 [internet publication]. [Full Text]
35. American Academy of Ophthalmology. Adjustable sutures in the treatment of strabismus; a report by the American Academy of Ophthalmology. Aug 2021 [internet publication].[Full Text]
36. Mehner L, Ng SM, Singh J. Interventions for infantile esotropia. Cochrane Database Syst Rev. 2023 Jan 16;1(1):CD004917.[Abstract]
37. Bradbury JA, Taylor RH. Severe complications of strabismus surgery. J AAPOS. 2013 Feb;17(1):59-63.[Abstract][Full Text]
38. Bort-Martí AR, Rowe FJ, Ruiz Sifre L, et al. Botulinum toxin for the treatment of strabismus. Cochrane Database Syst Rev. 2023 Mar 14;3(3):CD006499.[Abstract]
39. Gardner R, Dawson EL, Adams GG, et al. Long-term management of strabismus with multiple repeated injections of botulinum toxin. J AAPOS. 2008 Dec;12(6):569-75.[Abstract]
40. Ripley L, Rowe FJ. Use of botulinum toxin in small-angle heterotropia and decompensating heterophoria: a review of the literature. Strabismus. 2007 Jul-Sep;15(3):165-71.[Abstract]
41. Scott AB, Alexander DE, Miller JM. Bupivacaine injection of eye muscles to treat strabismus. Br J Ophthalmol. 2007 Feb;91(2):146-8.[Abstract]
42. Miller JM, Scott AB, Danh KK, et al. Bupivacaine injection remodels extraocular muscles and corrects comitant strabismus. Ophthalmology. 2013 Aug 2;120(12):2733-40.[Abstract]
43. Debert I, Miller JM, Danh KK, et al. Pharmacologic injection treatment of comitant strabismus. J AAPOS. 2016 Apr;20(2):106-11.[Abstract][Full Text]
44. Hopker LM, Modelli R, Allemann N. Bupivacaine injection combined with recession of antagonist rectus muscle to treat sensory strabismus. Strabismus. 2019 Feb 7;27(1):6-10.[Abstract]
45. Fawcett SL, Birch EE. Risk factors for abnormal binocular vision after successful alignment of accommodative esotropia. J AAPOS. 2003 Aug;7(4):256-62.[Abstract]
46. Romanchuk KG, Dotchin SA, Zurevinsky J. The natural history of surgically untreated intermittent exotropia - looking into the distant future. J AAPOS. 2006 Jun;10(3):225-31.[Abstract]
47. Buck D, Powell CJ, Rahi J, et al. The improving outcomes in intermittent exotropia study: outcomes at 2 years after diagnosis in an observational cohort. BMC Ophthalmol. 2012 Jan 18;12:1.[Abstract][Full Text]
48. Baker JD. Twenty-year follow-up of surgery for intermittent exotropia. J AAPOS. 2008 Jun;12(3):227-32.[Abstract]
49. Buck D, Powell CJ, Sloper JJ, et al. Surgical intervention in childhood intermittent exotropia: current practice and clinical outcomes from an observational cohort study. Br J Ophthalmol. 2012 Oct;96(10):1291-5.[Abstract]
50. Schmucker C, Kleijnen J, Grosselfinger R, et al. Effectiveness of early in comparison to late(r) treatment in children with amblyopia or its risk factors: a systematic review. Ophthalmic Epidemiol. 2010 Jan-Feb;17(1):7-17.[Abstract]
51. Jackson S, Harrad RA, Morris M, et al. The psychosocial benefits of corrective surgery for adults with strabismus. Br J Ophthalmol. 2006 Jul;90(7):883-8.[Abstract]
52. Mojon-Azzi SM, Mojon DS. Strabismus and employment: the opinion of headhunters. Acta Ophthalmol. 2009 Nov;87(7):784-8.[Abstract]
53. Mojon-Azzi SM, Potnik W, Mojon DS. Opinions of dating agents about strabismic subjects' ability to find a partner. Br J Ophthalmol. 2008 Jun;92(6):765-9.[Abstract]
54. Mohney BG, McKenzie JA, Capo JA, et al. Mental illness in young adults who had strabismus as children. Pediatrics. 2008 Nov;122(5):1033-8.[Abstract]
