​Strabismus (Crossed Eyes)


When your two eyes do not work in alignment, it appears as if the two eyes are not looking at the same place at the same time. This is commonly known as ‘crossed eye’, a disorder called strabismus.  

There are two kinds of strabismus:

  • Alternating strabismus – where the two eyes are misaligned alternately

  • Unilateral strabismus – where misalignment occurs in one eye only

Strabismus is caused by poor eye muscle control. Each eye is supported by six muscles which receive signals from the brain. In people with strabismus, eye movement control is not strong, leading to the affected eye turning in, out, up or down. Eventually, untreated strabismus leads to poor vision in the affected eye, since the brain gets conditioned to ignore the image from the affected eye as a response to the confusion created when two separate images are sent from both eyes. In severe cases, strabismus can lead to ‘lazy eye’, a condition known as amblyopia. 

In most cases, however, this disorder will not affect your ability to see. Your peripheral (sideways) vision and depth perception may not be very sharp and you may have to strain your eyes to be able to see at times.

Strabismus is a common disorder in children, with some being born with it (congenital strabismus) and others acquiring it later on (acquired strabismus). People with a family history of strabismus, those with severe farsightedness, adults suffering from a brain disorder or diabetics are at increased risk of developing this condition. 

If strabismus is not treated at the right time in children, it continues into adulthood. Most adults who have strabismus were born with it. In some cases, adults may develop strabismus later in life due to another serious disorder, such as a stroke or, in less serious cases, an eye injury. Sudden onset of strabismus later in adulthood must be evaluated immediately by a doctor.

You may be able to identify misalignment in your vision at all times, or symptoms may be particularly pronounced when you or your child is tired or feeling unwell. 

The general signs and symptoms of strabismus are:

  • Eyes looking in different directions

  • Misaligned movement of both eyes

  • Poor depth perception

  • Squinting and straining your eyes

  • Tilting the head to one side

  • Double vision in some cases

  • Closing or covering one eye when doing close work

  • Inability to read comfortably

New-borns may show signs of strabismus initially. However, this improves within three months. If your new-born’s strabismus continues beyond three months, you must immediately get your child evaluated by an ophthalmologist (eye specialist).

The earlier strabismus is detected and treated, the better the outcome of any treatment plan. That's why, if you or your child has been facing the above symptoms, you must seek professional medical advice.

In adults, sudden onset of strabismus could indicate another serious underlying disorder, and therefore immediate medical attention is necessary. If your new-born's strabismus does not improve after three months, a visit to the doctor is essential.

At The Aga Khan University Hospital the only internationally accredited hospital of Pakistan, you can be assured of receiving the best quality medical care. We have a highly competent team of ophthalmologists with whom you can safely and privately discuss your symptoms, gain advice and receive personalized treatment and care.

Your time with your doctor may be limited, so make sure to prepare for your visit beforehand. Here are some tips to help get you started.

Besides your medical history, comprehensive eye exams help in the diagnosis of strabismus. Some of these are:

  • Visual Acuity test to see if your vision has been affected 

  • Refraction test, which is conducted with the help of special instruments and various lenses to assess your eyes’ ability to focus

  • Cover/uncover test to measure deviation and eye movement

  • Corneal light reflex test to check for crossed eyes

  • General examination of the structures inside your eye, including the retina

The earlier the symptoms are diagnosed, the greater the chances that vision will be protected. Discuss your symptoms, concerns and queries in detail with your eye specialist working for the Eye and ENT Service Line of The Aga Khan University Hospital for an accurate diagnosis and treatment of your disorder.

Initially strabismus in children will be treated with the help of prescription eye glasses. If one of your child's eyes has become amblyopic or 'lazy eye', the doctor will prescribe eye patches to be placed over the normal eye to force the affected eye to get better vision. You must ensure that your child wears the eye patch properly as prescribed, as this is essential for the treatment plan to be effective. In case these treatment methods do not work, eye muscle surgery may be recommended, though it may not fix the vision of an amblyopic 'lazy eye'.

In adults as well, corrective eye glasses or special lenses may be prescribed, as well as muscle exercises to help keep the eyes aligned. In serious cases, surgery may be required to correct strabismus. Sometimes, injected medication (Botox) may be useful in relaxing the eye muscles and making it easier for the eyes to focus.

Make sure you discuss the risks and complications of surgery against possible benefits in detail with your doctor.

The Aga Khan University Hospital offers various support services to help with managing or recovering from the disease or condition. These include but are not limited to nutrition, physiotherapy, rehabilitation, specialized clinics and some patient support groups. Your doctor or nurse will advise you accordingly.

 The Aga Khan University Hospital offers financial assistance to those who are in need and fulfil the eligibility criteria. For further information, you can contact the Patient Welfare Department. You can find the contact number of the Patient Welfare Department in the 'Important Numbers' section on the website homepage.

 The financial counselling staff is available during office hours, at the main PBSD (Patient Business Services Department), to answer your financial queries on treatments' costs and authorize admissions on partial deposit as per hospital policies allow. The financial counsellor in the emergency room is open 24/7. You can find the contact number of the Patient Business Services in the 'Important Numbers' section on the website homepage.

Your doctor and or nurse will give you specific instructions about the prescribed medication. Please ensure that you take or use the prescribed medicine as advised. It can be dangerous to your health if you self-prescribe. Please inform the doctor or nurse beforehand if you have experienced any adverse reactions to any medications in the past. If you experience any symptoms of drug poisoning, overdose or severe reaction please contact the Pharmacy Service at The Aga Khan University Hospital immediately. You can find the contact number of the Pharmacy Services in the 'Important Numbers' section on the website homepage




The information provided on our website is for educational purposes and not intended to be a substitute for medical advice, diagnosis or treatment. You should always seek the advice of your doctor or other healthcare professional provider.