Can children outgrow strabismus?

True strabismus generally does not resolve on its own and requires evaluation and treatment. Intermittent misalignment in very young infants can be normal, but persistent or constant misalignment should be assessed promptly.

Why does new double vision in an adult need urgent evaluation?

New-onset strabismus with double vision in adults can signal cranial nerve palsy, thyroid eye disease, myasthenia gravis, or other neurologic or systemic conditions, so it warrants prompt, targeted evaluation.

Is strabismus surgery only cosmetic?

No. Beyond improving alignment and appearance, surgery can relieve double vision and, in children treated within the sensitive period, help preserve binocular vision and depth perception.

Pediatrics & Binocular VisionOphthalmologyOptometry

Strabismus

Also known as: Ocular misalignment, Esotropia, Exotropia, Crossed eyes

Overview

Strabismus is a misalignment of the eyes in which they do not point at the same target simultaneously, and it affects both children and adults. It can cause amblyopia and loss of binocular vision in childhood and diplopia in adults. Management ranges from refractive correction and prism to extraocular muscle surgery, depending on the type and cause.

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Definition: Misalignment of the eyes
Common types: Esotropia, exotropia, hyper/hypotropia
Childhood risk: Amblyopia, loss of stereopsis
Adult symptom: Double vision

Key clinical points

Strabismus is classified by direction (eso, exo, hyper/hypo) and whether it is constant or intermittent.
In children, it can cause amblyopia and impaired binocular vision.
New-onset strabismus or diplopia in adults may indicate neurologic or systemic disease.
Refractive correction, especially for accommodative esotropia, can realign the eyes.
Prism and extraocular muscle surgery correct residual or larger deviations.

Classification

Strabismus is described by the direction of deviation—esotropia (inward), exotropia (outward), and vertical deviations—and by whether it is constant or intermittent and the same in all gaze directions (comitant) or not (incomitant). Comitant deviations are common in childhood, while incomitant, especially acute, deviations raise concern for cranial nerve palsies or other neurologic causes.

Evaluation

Assessment measures the deviation with cover testing, evaluates ocular motility and binocular function, and includes cycloplegic refraction because uncorrected hyperopia commonly drives accommodative esotropia. Children are additionally assessed for amblyopia. New-onset or incomitant strabismus and diplopia in adults prompt evaluation for neurologic, orbital, or systemic causes such as thyroid eye disease or myasthenia.

Treatment

Correcting refractive error can fully or partially realign accommodative esotropia. Amblyopia is treated concurrently in children. Prisms relieve diplopia in adults, and extraocular muscle surgery realigns the eyes when deviations are large or not fully corrected optically. Botulinum toxin has a role in selected cases.

Goals include restoring alignment, relieving double vision, and, in children, preserving binocular vision and appearance.

Frequently asked questions

Can children outgrow strabismus?: True strabismus generally does not resolve on its own and requires evaluation and treatment. Intermittent misalignment in very young infants can be normal, but persistent or constant misalignment should be assessed promptly.
Why does new double vision in an adult need urgent evaluation?: New-onset strabismus with double vision in adults can signal cranial nerve palsy, thyroid eye disease, myasthenia gravis, or other neurologic or systemic conditions, so it warrants prompt, targeted evaluation.
Is strabismus surgery only cosmetic?: No. Beyond improving alignment and appearance, surgery can relieve double vision and, in children treated within the sensitive period, help preserve binocular vision and depth perception.

References & further reading

Pediatrics & Binocular Vision

Amblyopia

Amblyopia is reduced best-corrected vision in one or both eyes due to abnormal visual development during childhood, without a structural lesion that fully explains the loss. It is the most common cause of monocular vision impairment in children. Because the visual system is most plastic early in life, timely detection and treatment are critical to a good outcome.

Clinical overview Pediatrics & Binocular Vision

Myopia

Myopia (nearsightedness) is a refractive error in which distant objects appear blurred because light focuses in front of the retina, usually due to an elongated eye. Its prevalence is rising globally, and high myopia carries lifelong risks of retinal detachment, myopic maculopathy, and glaucoma. Modern myopia management aims to slow axial elongation in children, not merely correct blur.

Clinical overview