Don’t look now, but something seems wonky with your baby’s eyes. One eye will be looking at you straight on, while the other wanders. The wandering eye could be looking in, out, up, or down.
Sometimes both eyes may seem off-kilter. This cross-eyed gaze is adorable, but it has you kind of freaked out. Why can’t your baby focus? And will they be in specs before they’re ever out of diapers?
Not to worry. This is normal as your baby’s muscles develop and strengthen and they learn to focus. It usually stops by the time they’re 4–6 months old.
Strabismus, or a misalignment of the eyes, is common in newborns and babies, and it can occur in older kids as well. About 1 in 20 kids has strabismus, also known as a wandering or crossed eye to those of us without a long list of letters after our names.
Your baby can have two crossed eyes or just one, and the crossing can be constant or intermittent. Again, it’s often normal as your baby’s not-yet-fully-developed brain and eye muscles learn to work in unison and coordinate their movements.
Talking to your pediatrician
While it may be common, strabismus is still something to keep your eye on. If your baby’s eyes are still crossing at about 4 months of age, it’s time to get them checked out.
Having a crossed eye may not be just a cosmetic problem — your child’s sight could be at stake. For example, over time, the straighter, more dominant eye can compensate for the wandering eye, which can result in some vision loss in the weaker eye as the brain learns to ignore its visual messages. This is called amblyopia, or lazy eye.
Most young children with strabismus are diagnosed between the ages of 1 and 4 — and the earlier the better, before connections between the eye and the brain are fully developed. There are a variety of treatments, from patches to glasses to surgery, that can straighten your child’s crossed eye and preserve their vision.
Eyes don’t cross just one way. There’s inward, outward, upward, downward — and, thanks to the medical establishment’s love of Greek words, there are fancy names for each. According to the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) the different types of strabismus include:
- Esotropia. It’s characterized by having one or both eyes turn inward toward the nose. This is the most common type of strabismus and affects between 2 to 4 percent of children.
- Exotropia. This type involves one or both eyes turning outward toward the ear. This is also sometimes called wall-eye, and it affects 1 to 1.5 percent of kids.
- Hypertropia. This is when the eyes are misaligned, with the abnormal one sitting higher than the other eye. It affects about 1 in 400 kids.
- Hypotropia. You can think of this as the opposite of hypertropia — the abnormal eye sits lower than the other.
In addition to which direction the eyes turn, doctors break down cases of strabismus even further. Common classifications include:
- Infantile esotropia. According to the American Academy of Ophthalmology (AAO), up to 1 in 50 babies are born with this eye disorder. Cases that don’t resolve on their own by 4 months of age need medical treatment.
- Accommodative esotropia. This can be the result of severe farsightedness and usually occurs after your baby’s first birthday. It tends to start gradually and then becomes more constant.
- Pseudostrabismus. Because a lot of babies can have a wide nose bridge and some extra skin folds at the inner corners of their eyes, they can appear to have crossed eyes when they really don’t. Babies with pseudostrabismus usually grow into their facial features, replete with forward-looking eyes, by 2 to 3 years of age.
It’s important to note that not every case of strabismus will be easily visible to the naked eye. Talk to your child’s pediatrician if you notice any of the following, regardless of whether your baby’s eyes seem crossed or not:
- Frequent squinting or blinking, especially in bright light. It could be a signal that your baby is experiencing double vision.
- Turning or tilting of the head. It may be a sign your baby is trying to line up an object in their field of vision.
Strabismus is caused by eye muscles that don’t work in unison — but why these muscles don’t work together is a mystery to experts. They do know, however, that certain kids run a higher risk of having crossed eyes than others. They include:
- Children who have a family history of strabismus, particularly having a parent or sibling with crossed eyes.
- Children who are farsighted.
- Children who have had trauma to the eye — for example, from cataract surgery (yep, babies can be born with cataracts).
- Children with neurological or brain development issues. Nerves in the eyes send signals to the brain to coordinate movement, so children born prematurely or with conditions like Down syndrome, cerebral palsy, and brain injuries have a greater chance of having strabismus of some kind.
According to the AAP, a vision screening (to check for eye health, vision development, and eye alignment) should be a part of every baby’s well visit starting at 6 months of age. If it’s determined that your baby’s eyes do, indeed, cross, they’ll receive one of several treatments depending on the severity of the strabismus.
Treatments for mild crossed eyes include:
- Eyeglass to correct vision in the weaker eye or blur vision in the good eye so the weaker eye is forced to strengthen.
- An eye patch over the non-wandering eye, which forces your baby to use the weaker eye to see. The goal is to strengthen those weaker eye muscles and correct vision.
- Eye drops. These act much like an eye patch, blurring vision in your child’s good eye so they have to use the weaker one to see. This is a good option if your baby won’t keep an eye patch on.
For more severe strabismus, options include:
While your baby is under general anesthesia, the eye muscles are tightened or loosened to align the eyes. Your baby might need to wear an eye patch and/or receive eye drops, but in general, recovery only takes a few days.
Babies whose eyes are nearly always crossed are more apt to wind up with surgery than those who only occasionally cross their eyes. In some cases, a doctor will use adjustable sutures, which allow them to tweak eye alignment after surgery.
Under anesthesia, a doctor will inject an eye muscle with Botox to weaken it. By loosening up the muscle, eyes may be able to align properly. The injections might need to be periodically repeated, but in some cases, the effects can be long lasting.
Yet, the Food and Drug Administration (FDA) has noted that the safety and effectiveness of botox in pediatric patients below the age of 12 have not been established.
Strabismus can’t be prevented, but early detection and treatment are key.
Besides lasting vision problems, babies with untreated strabismus can have delays reaching developmental milestones, such as grasping objects, walking, and standing. Kids who are diagnosed and treated early have the best shot at having healthy vision and development.
Don’t get too stressed out if your infant looks at you cross eyed sometimes. It’s pretty common in the first few months of life.
But if your baby is older than 4 months and you’re still noticing some suspect stares, get them checked out. There are effective treatments available, and some of them, like glasses and patches, are simple and noninvasive.