Eye Deviation
Eye deviation, medically known as strabismus, occurs when the eyes don't align properly and point in different directions. One eye may look straight ahead while the other turns inward, outward, upward, or downward. This misalignment can be constant or intermittent and affects both children and adults. While some cases are present from birth or develop in childhood, sudden onset in adults often signals serious neurological conditions requiring immediate evaluation. Understanding the types, causes, and warning signs helps ensure appropriate treatment and prevents vision loss or underlying health complications.
🚨 SEEK IMMEDIATE MEDICAL CARE For:
- Sudden onset eye deviation in adults
- Eye deviation with severe headache
- Double vision (diplopia)
- Eye deviation after head injury
- Deviation with facial drooping or weakness
- Difficulty speaking or swallowing
- Eye deviation with altered consciousness
- Pupil size differences
- Eye pain with deviation
- Vision loss
These symptoms may indicate stroke, brain tumor, or other serious neurological conditions.
Understanding Eye Deviation
Eye movement is controlled by six muscles attached to each eye, coordinated by nerves originating in the brain. When these muscles don't work together properly, the eyes point in different directions. This misalignment disrupts binocular vision - the ability to use both eyes together - which is essential for depth perception and clear vision.
In children, the brain may suppress the image from the misaligned eye to avoid double vision, potentially leading to amblyopia (lazy eye). In adults, sudden eye deviation typically causes double vision because the brain cannot easily suppress one image.
Types of Eye Deviation
Direction of Deviation
- Esotropia: Eye turns inward (crossed eyes)
- Exotropia: Eye turns outward (wall eye)
- Hypertropia: Eye turns upward
- Hypotropia: Eye turns downward
- Mixed patterns possible
Timing Patterns
- Constant: Always present
- Intermittent: Comes and goes
- Alternating: Switches between eyes
- Worse when tired or ill
- May worsen with near or far viewing
Age of Onset
- Congenital: Present at birth
- Infantile: Develops before 6 months
- Acquired childhood: After age 2
- Adult onset: New in adulthood
- Different implications by age
Severity
- Small angle (barely noticeable)
- Moderate deviation
- Large angle (obvious)
- May vary by gaze direction
- Can progress over time
Common Causes
In Children
- Idiopathic: No identifiable cause (most common)
- Refractive errors: Farsightedness causing crossing
- Muscle weakness: One or more weak eye muscles
- Genetic factors: Family history of strabismus
- Prematurity: Increased risk in premature infants
- Developmental delays: Associated conditions
In Adults
- Stroke: Damage to eye movement centers
- Brain tumor: Pressure on nerves or brain
- Head trauma: Nerve or brain injury
- Thyroid eye disease: Graves' ophthalmopathy
- Myasthenia gravis: Muscle weakness
- Diabetes: Nerve damage (diabetic neuropathy)
- Multiple sclerosis: Nerve inflammation
- Aneurysm: Pressure on cranial nerves
Associated Symptoms
Eye deviation often occurs with:
- Double vision: Seeing two images (adults)
- Blurred vision: Difficulty focusing
- Eye strain: Fatigue from compensation
- Headaches: From eye strain or underlying cause
- Head tilting: Compensatory positioning
- Closing one eye: To avoid double vision
- Poor depth perception: Difficulty judging distances
- Reading difficulties: Words jumping or moving
- Light sensitivity: Photophobia
- Dizziness: From visual confusion
Risk Factors
- Family history: Genetic predisposition
- Premature birth: Underdeveloped eye control
- Refractive errors: Uncorrected vision problems
- Neurological conditions: Cerebral palsy, Down syndrome
- Eye injuries: Muscle or nerve damage
- Systemic diseases: Diabetes, thyroid disease
- Brain conditions: Tumors, hydrocephalus
- Medications: Some drugs affect eye muscles
Medical Evaluation
Eye Examination
- Visual acuity testing
- Cover/uncover test
- Light reflex test
- Eye movement assessment
- Binocular vision testing
- Refraction measurement
Additional Tests
- Neurological exam: If adult onset
- Brain MRI/CT: Rule out tumors or stroke
- Blood tests: Thyroid, myasthenia gravis
- Lumbar puncture: If infection suspected
- Electromyography: Muscle function
Treatment Options
Non-Surgical
- Corrective glasses or contacts
- Prism lenses
- Eye patching (children)
- Vision therapy exercises
- Botox injections
- Treatment of underlying cause
Surgical
- Eye muscle surgery
- Adjustable suture techniques
- Multiple surgeries may be needed
- Done under general anesthesia
- Outpatient procedure usually
- Recovery 1-2 weeks
For Children
- Early treatment crucial
- Prevent amblyopia
- Patching strong eye
- Atropine drops
- Regular monitoring
- School accommodations
For Adults
- Treat underlying cause first
- Prisms for double vision
- Eye muscle exercises
- Surgery if stable
- Occupational modifications
- Driving restrictions possible
Living with Eye Deviation
- Regular eye exams: Monitor progression
- Wear prescribed glasses: Consistently
- Eye exercises: As recommended
- Good lighting: Reduce eye strain
- Take breaks: When reading or using screens
- Safety precautions: Impaired depth perception
- Support groups: For children and parents
- School/work accommodations: As needed
Potential Complications
- Amblyopia: Permanent vision loss in weaker eye
- Loss of binocular vision: No 3D vision
- Social/psychological: Self-esteem issues
- Academic difficulties: Reading problems
- Injury risk: Poor depth perception
- Chronic headaches: Eye strain
- Limited career options: Some require binocular vision
When to See a Doctor
Immediate Care
- Sudden onset in adults
- Eye deviation after injury
- With neurological symptoms
- Severe headache or vision loss
Schedule Appointment
- Any eye misalignment in children
- Intermittent eye turning
- Family history of strabismus
- Eyes don't track together
- Head tilting or one eye closing
- Failed vision screening