Strabismus (deviation of the eyes) affects approximately two percent of the nation's children, half of whom are born with the condition. It is critical that this handicap be diagnosed and corrected at an early age since children with uncorrected strabismus may go on to develop amblyopia ("lazy eye"), a dimming of vision in an
eye that has not been used.

The term strabismus is used to describe eyes that are not straight or properly aligned. This misalignment results from the failure of the eye muscles to work together. One eye or sometimes both may turn in (crossed eyes) as shown in Taylor's photo below, or turn out (wall eyes), turn up or turn down.

Sometimes, more than one of the "turns" are present. The deviation may be constant or it may come and go.It may be present at birth, become apparent at a large age, or result after an illness or accident.

The patterns of deviation can vary among individuals. In alternating strabismus, the eyes "take turns" wandering. Strabismus can be more marked in some people when they use their eyes for near activities and in others when they are focusing for distance or simply day-dreaming. In the young child, strabismus may vary not only from day-to-day, but during the course of a day. Usually the condition is worse when a child is tired, ill or emotionally upset. At birth, an infant's eyes cannot always focus directly on objects. They may appear to move quite independently at first, sometimes crossing, and sometimes wandering outward. But by the age of 3 to 4 months, an infant's eyes should have the ability to focus on small objects and the eyes should be s traight or parallel. A 6-month-old infant should be able to focus on both distant and near objects. If parents notice crossed or wall eyes persisting in a child 4 months of age, they should immediately take the child to an eye care professional for an examination. Early medical attention is recommended for another important reason to rule out the presence of a serious disease, such as a tumor. It is recommended that all children have an eye exam by the age of 6 months.

In order to understand strabismus, it is helpful to know how vision works. The process of vision is complex. The eye receives light waves which are focused on the retina (the rear lining of the eye) and transmitted from there to the brain. The brain, in turn, creates a single image from the separate ones it has received from the two eyes; this is known as fusion. To develop normal, binocular (two-eyed) vision, a child needs two healthy, well-coordinated eyes with relatively equal vision in each so that the images that form on the retina will have comparable clarity. If the muscles that move each eyeball have developed correctly, the eyes will work together as a team. If the eye muscles are not coordinated and one eye is looking directly at an object while the other turns in or out, the message from the eye that is on target will usually be stronger that the message from the other eye. As a consequence, the brain may simply ignore the weaker message. This solves the child's double vision problem, but creates another; the eye whose message is ignored develops weaker vision amblyopia.

Certain children may appear to have strabismus when, in fact, they do not. An extra fold of skin that hides some of the white in the inner corner of the eyes may cause the eyes to look crossed. A broad, flat nose, or eyes that are unusually close together may also produce such an effect. Occasionally, if the child's eyes are set somewhat apart, it may appear as if one eye is turning outward. All of these are examples of false strabismus. This false strabismus should disappear as the child's face grows. Treatment in such cases is unnecessary. After a professional examination, a parent's concern can be quickly dispelled if false strabismus is present.

Strabismus may occur from several causes, such as birth injuries, heredity, faulty muscle attachments, need for glasses, excessive farsightedness, or body illnesses. The major goals in treating strabismus are the development of normal vision in each eye, including fusion and depth perception. Accomplishing these goals often involve straightening the eyes and preventing amblyopia from developing.

The preschool years are critical ones in the development of a child's eyes. Parents should continue to watch for any misalignment, slight or marked, and for wandering of one or both eyes. A professional eye examination for every child, including those who do not display any signs of eye trouble, is recommended shortly after birth, at 6 months of age, before entering school (age 4 or 5) and periodically throughout the school years. By the time a child is 5 or 6, vision is usually 20/20, or at the normal adult level, which means that lettering of a certain size can be seen from 20 feet. An eye deviation that persists until a child is 7, may result in permanent visual impairment. Besides hindering the development of useful vision, strabismus may affect the child's personality. A child may suffer embarrassment from a cosmetic defect that makes him look different.

Strabismus cannot be outgrown, nor will it improve by itself. Treatment to straighten the eyes is needed. The types of treatment listed below may be used alone or in combination. The choice and order vary with the type of strabismus and its cause. GLASSES are commonly prescribed to improve focusing and redirect the line of sight, enabling the eyes to straighten which Taylor had an attempt with this type of procedure as in below photo and was not successful.

MEDICATION in the form of eye drops or ointment that blur vision in one eye, can be a substitute for patching. Use of blurring drops is not appropriate in every case and is generally a less successful approach. In other cases, different drops may be used to replace glasses, or to add to the strength of glasses when more help is needed to control increased visual problems at near viewing. Injected medication may be used to selectively weaken an eye muscle that is overly active.

SURGERY may be performed on the eye muscles which Taylor received to straighten the eyes as shown below if non-surgical means are unsuccessful.

EYE EXERCISES (orthoptics), a limited form of treatment, may be recommended either before or after surgery to teach proper eye coordination.There are many types of strabismus and no single treatment is best or all-inclusive, nor is it always successful. Successful treatment of strabismus far outnumbers failures, however, especially if the parents seek help when the child is still young.