It is common for babies to appear cross-eyed, and this is usually a normal part of their early development. While many parents observe their infant’s eyes seeming to wander or cross, it often does not indicate a lasting vision problem. This temporary appearance is distinct from a medical condition known as strabismus, which involves a true misalignment of the eyes. Understanding the differences between these instances can help parents determine when to seek professional advice.
Why Babies May Appear Cross-Eyed
Newborns may appear cross-eyed due to common developmental factors. One reason is epicanthal folds, skin folds extending from the upper eyelid to the inner corner of the eye. These folds are common in infants and create an optical illusion, making eyes seem to turn inward when aligned. As a baby grows and facial features mature, especially the nose bridge, these folds become less prominent, and eyes appear straight.
Another factor is the immaturity of a newborn’s eye muscles. At birth, a baby’s vision is limited, and eye muscles are not yet fully coordinated or strengthened, leading to occasional, brief instances where eyes appear to wander or cross. For the first two to four months, it is normal for a baby’s eyes to occasionally wander outward or cross inward. These instances are fleeting and not constant, as the brain and eye muscles learn to work in unison. By around four months of age, most babies gain better control over their eye muscles and move their eyes together more consistently.
Recognizing True Strabismus
While occasional eye wandering is normal in infants, persistent misalignment can indicate a condition called strabismus. Strabismus is a visual disorder where the eyes do not look in the same direction at the same time. One eye might turn inward, outward, upward, or downward, while the other eye looks straight ahead. This misalignment can be constant or intermittent.
Parents should be aware of signs that suggest true strabismus. If a baby’s eyes continue to cross or wander frequently after four months, it is a concern. Constant eye crossing at any age also indicates a need for professional evaluation. Other signs include one eye consistently turning in or out, eyes that do not focus together, frequent squinting or blinking, or tilting the head to align vision. Strabismus can be subtle, making early detection important.
Addressing Strabismus
If true strabismus is diagnosed, early detection and intervention prevent long-term vision problems. Untreated strabismus can lead to amblyopia, or “lazy eye,” where the brain ignores visual input from the misaligned eye. The brain is most adaptable during early childhood, making it easier to correct the vision imbalance if treatment begins promptly.
Strabismus can stem from various causes, including problems with eye muscles, their controlling nerves, or the brain’s eye movement control. Other factors include family history, farsightedness, premature birth, or neurological conditions. Treatment approaches vary depending on cause and severity. Options include corrective eyeglasses, patching therapy (covering the stronger eye to encourage the weaker eye), or eye exercises. In some cases, eye muscle surgery may be recommended to correct alignment.