A wandering eye, medically known as strabismus, describes a condition where the eyes do not align properly. Instead of looking in the same direction, one eye may turn inward, outward, upward, or downward. This misalignment means the eyes do not work together to focus on a single object. While more commonly observed in children, strabismus can also affect adults, appearing occasionally or constantly.
Understanding the Condition
A wandering eye manifests as a visible misalignment where one eye deviates from the point of focus while the other remains straight. This deviation can be inward (esotropia), outward (exotropia), upward (hypertropia), or downward (hypotropia). These misalignments can be consistently present or appear intermittently, such as when a person is tired.
The condition can affect one eye consistently (unilateral strabismus) or alternate between both eyes (alternating strabismus). In some instances, the eyes may appear misaligned due to facial features, a condition called pseudoesotropia, where the eyes are actually straight.
Underlying Causes
A wandering eye stems from issues with the intricate system that controls eye movement. Six muscles attach to each eye, allowing for precise movement and coordination. Strabismus can arise from problems with these eye muscles, preventing them from working together effectively. Issues with the nerves that transmit signals to these eye muscles, such as damage to the third, fourth, or sixth cranial nerves, can also disrupt eye movement. The brain’s control center, responsible for coordinating eye movements, can also contribute if its pathways are disrupted.
Genetic factors often play a role, with a family history of the condition increasing an individual’s likelihood of developing it. Certain medical conditions are also associated with strabismus, including significant farsightedness, which can cause eyes to turn inward due to the extra effort required for focusing. Neurological disorders like cerebral palsy, Down syndrome, hydrocephalus, brain tumors, stroke, and head injuries can contribute to its onset.
Diagnosis
An eye care professional diagnoses a wandering eye through a comprehensive eye examination. This evaluation includes assessing the patient’s medical history for symptoms, family history, and general health issues. Visual acuity tests measure how well a person sees, often by reading letters on an eye chart or observing a young child’s visual responses. Eye movement assessments observe how the eyes track objects and work together.
Specific tests include the Hirschberg test, which assesses the corneal light reflex for eye alignment. Cover tests, like the cover-uncover and alternate cover tests, help reveal eye deviation by observing movements when one eye is covered. Refraction tests determine the appropriate corrective lens prescription by checking how the eyes focus light.
Treatment Options
Various methods manage a wandering eye, with the chosen approach depending on its specific type and cause. Corrective eyewear, such as glasses or contact lenses, can help align the eyes, particularly if strabismus is linked to uncorrected farsightedness. Prism lenses, which bend light, may also be prescribed to reduce eye turning and address double vision.
Patching therapy, also known as occlusion therapy, is often used when a wandering eye leads to amblyopia (“lazy eye”). This involves covering the stronger eye to encourage the weaker, misaligned eye to develop better vision. Vision therapy involves structured eye exercises designed to improve eye coordination, focusing, and teaming skills. If non-surgical treatments are insufficient, surgical intervention may be considered. Strabismus surgery adjusts the length or position of the eye muscles to realign the eyes, either by tightening (resection) or loosening (recession) them.
Importance of Early Management
Prompt treatment for a wandering eye is important, particularly for children. Early intervention significantly improves the likelihood of successful alignment and visual outcomes. Without timely management, a wandering eye can lead to amblyopia, where the brain suppresses the image from the misaligned eye to avoid double vision. This can result in reduced vision and potential permanent vision loss if not addressed during the critical period of visual development.
Early treatment also supports the development of proper binocular vision, the ability of both eyes to work together to create a single, three-dimensional image. This coordinated vision is fundamental for depth perception and overall visual function. Addressing strabismus early can help prevent long-term visual impairments and support a child’s visual development.