Strabismus

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Last reviewed: August 2019

Last updated: August 2019

Summary

Misalignment of the visual axes of the eyes; may be latent or manifest and, if manifest, it may be constant or intermittent.

Common cause of diplopia (double vision) and visual confusion (seeing different objects in the same place) in adults.

Important cause for amblyopia (decreased vision in an anatomically normal eye caused by suppression) in children.

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.

Treatment is directed at restoring and maintaining ocular alignment, eliminating diplopia or visual confusion, enabling binocular vision, and restoring normal appearance.

If strabismus is secondary to an underlying cause (e.g., abducens nerve [cranial nerve VI] palsy causing esotropia), treatment of this condition is necessary.

Definition

Strabismus refers to a misalignment of the eyes. If strabismus develops in adults, it can cause diplopia (double vision) and visual confusion (seeing different objects in the same location), and it is an important cause of amblyopia in children. [1] Whereas normally both eyes fixate (look at) the object of interest, in strabismus one eye fixates and the other (nonfixating eye) is deviated.

History and exam

Key diagnostic factors

diplopia
eye misalignment
amblyopia

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Other diagnostic factors

abnormal eye movements
visual confusion
asthenopia
intermittent closure of one eye
cranial nerve palsy

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Risk factors

family history of strabismus
prematurity
refractive error

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Diagnostic investigations

1st investigations to order

cover test
simultaneous prism and cover test (SPCT)
uncover test (UCT)
alternate prism cover test (APCT)
Hirschberg test
Krimsky test

Full details

Investigations to consider

version testing
duction testing
forced duction testing
CT or MRI of orbit
MRI of brain
CT chest

Full details

Treatment algorithm

ACUTE

primary strabismus

secondary strabismus

Contributors

Authors VIEW ALL 

Daniel J. Salchow, MD

Daniel J. Salchow

Director

Pediatric Ophthalmology; Strabismus; Neuro-ophthalmology

Charité-Universitätsmedizin Berlin

Berlin

Germany

Disclosures

DJS declares that he has no competing interests.

Peer reviewers VIEW ALL 

Robert B. Avery, MD, PhD

Assistant Professor of Ophthalmology

Department of Surgery

University of New Mexico School of Medicine

Albuquerque

NM

Disclosures

RBA declares that he has no competing interests.

Peter Tiffin, BMedSci(Hons), MBBS, FRCOphth

Ophthalmology Consultant

City Hospitals Sunderland

Sunderland

UK

Disclosures

PT declares that he has no competing interests.

Jonathan Smith, MBBS, MRCP, MRCOphth

Specialist Registrar in Ophthalmology

Ophthalmics

Royal Victoria Infirmary

Newcastle

UK

Disclosures

JS declares that he has no competing interests.

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