A wandering or turned eye, also known as strabismus, is a condition where the eyes are misaligned and point in different directions. Strabismus affects around 4% of the population and can cause vision development problems in children if not treated early. However, with treatment, people with strabismus can still see perfectly fine out of both eyes.
What causes a wandering eye?
A wandering or turned eye is caused by a misalignment of the eye muscles that prevents both eyes from looking at the same place at the same time. This misalignment can be due to:
- A defect in binocular vision – the ability of both eyes to focus on a single point.
- A problem with the nerve signals between the brain and eye muscles.
- Genetics.
- Injury to the eye muscles or nerves.
- A problem with the brain’s visual processing center.
In newborns and young children, the eye alignment system is still immature, so strabismus is more common at this age. As a child grows and binocular vision develops, the eyes may straighten out on their own. But sometimes the condition persists and requires treatment.
Does a wandering eye affect vision?
If left untreated early in life, a turned eye can affect vision development in a few ways:
- Amblyopia (lazy eye) – The brain ignores input from the wandering eye, so visual acuity doesn’t develop properly in that eye.
- Depth perception – Both eyes need to look straight ahead to allow proper depth perception and 3D vision. A turned eye disrupts this process.
- Eye teaming – Two eyes working together is essential for tracking moving objects and other visual tasks. A turned eye prevents this eye teaming.
During the critical periods of visual development in infancy and early childhood, a turned eye can lead to permanent vision loss or depth perception problems if not treated.
But if caught and treated early, the vision development issues caused by a wandering eye can often be corrected. And even in adulthood, treatment can realign the eyes to restore single vision.
Do people with strabismus have double vision?
Double vision or seeing two different images is not common with strabismus, except in certain circumstances:
- If strabismus develops later in life due to illness, injury, or nerve damage. The eyes are not aligned properly, so the brain receives two different images.
- If strabismus is intermittent and the eyes switch between being aligned and misaligned. When they switch, double vision may briefly occur.
- If the eyes are realigned with treatment later in life. At first, the brain is getting images from a new angle and may see double.
In most cases of strabismus that begins in infancy or childhood, the brain adapts by ignoring input from the wandering eye. This suppression of one image avoids double vision, but leads to other vision development issues if not corrected.
Can people with strabismus have 20/20 vision?
Yes, many people with strabismus can have 20/20 vision or normal visual acuity. 20/20 vision simply means you can see clearly at 20 feet what should normally be seen at that distance.
If the wandering eye condition is treated early, the brain can develop normal visual acuity in both eyes. Though the eyes are misaligned, input from both eyes is still processed by the brain. With proper correction and eyeglasses, 20/20 vision can often be attained.
In some cases, amblyopia or lazy eye has already developed in the wandering eye. With patching therapy and vision exercises, this too can often be corrected early on. Even if mild vision impairment remains in the weaker eye, the other eye can still achieve 20/20 vision.
So people with strabismus can commonly have very good vision in at least one eye, allowing sharp 20/20 visual acuity. Proper eyeglasses and contacts can further compensate for refractive errors.
Can people with strabismus drive?
In most cases, people with strabismus can successfully drive with some adaptive techniques. While depth perception may be impaired, strong vision in one eye is adequate for safe driving.
Here are some driving tips for people with strabismus:
- Use the dominant eye with better vision for quick glances at side mirrors and gauges.
- Turn the head fully to increase the field of view when checking blind spots.
- Let a passenger assist with navigation and reading signs.
- Sit high in the seat to maximize viewing angles.
- Keep speedmoderate and increase following distance.
- Avoid heavy traffic situations until fully adapted to driving.
With practice, people with strabismus can feel confident driving while taking a few extra safety precautions. In some cases, restricted licenses may be issued limiting night driving or highways.
Modern cars with parking sensors, rearview cameras and collision warning systems can also aid with depth perception issues. And self-driving cars in the future would further accommodate people with eye misalignment.
What is the treatment for a wandering eye?
Several effective treatments can realign the eyes and restore vision in a wandering eye:
Eye Exercises
Orthoptic eye exercises train eye muscles to work together and point both eyes at the same object. These may be recommended along with patching therapy.
Eye Patches
Patching the strong eye forces use of the weaker, wandering eye and stimulates vision development. This is critical for correcting amblyopia in kids.
Prism Lenses
Special prism eyeglass lenses bend light to realign images into both eyes, allowing single vision.
Vision Therapy
customized in-office therapy trains eye coordination and refocuses a turned eye.
Surgery
Strabismus surgery can realign eye muscles and position for proper alignment.
The best results come from starting treatment early, typically before age 8. But vision can still be improved in adulthood as well. Treatment is tailored for the specific type and cause of eye misalignment present.
What are the different types of strabismus?
There are several common forms of strabismus or eye misalignment:
Esotropia – One or both eyes turn inward toward the nose. This is the most common type of strabismus.
Exotropia – One or both eyes turn outward. Is more common in adults than children.
Hypertropia – One eye turns upward. Can cause a head tilt to compensate.
Hypotropia – One eye turns downward, which is less common.
Intermittent exotropia – Eyes are misaligned some of the time but can switch to normal alignment.
Infantile esotropia – Eyes turn severely inward since infancy but improves over time.
The cause and treatment approach varies depending on the specific type of eye misalignment involved. An ophthalmologist evaluates this to recommend an effective treatment plan.
What professions evaluate and treat strabismus?
A team of eye care professionals diagnose and treat wandering eye conditions:
Ophthalmologist – Medical doctor specializing in eye disease, surgery, and vision correction. Diagnoses the cause and prescribes treatment.
Optometrist – Provides vision exams, eyeglasses and contact lens prescriptions to correct refractive errors.
Orthoptist – Allied health professional trained in eye exercises and therapy for eye alignment and movement disorders. Often directs vision therapy.
Optician – Fits and dispenses prescribed eyeglasses, contacts, and other optical aids like prisms.
For young children with strabismus, a pediatric ophthalmologist or pediatric optometrist specializing in children’s vision care is recommended. Ongoing follow-up care tracks visual development and response to early treatment.
What is the outlook for people with strabismus?
With early detection and treatment, the outlook for establishing good vision in both eyes is very positive. Amblyopia caused by strabismus can often be corrected through eye patching, exercises, and vision therapy in childhood.
Some degree of residual vision impairment or depth perception problems can persist. But detailed vision tasks can still be performed well with one eye, and adaptive techniques help in activities like driving. Eyeglasses and contact lenses continue providing vision correction into adulthood.
For adults with new onset strabismus, double vision and disruption of work tasks may occur. But prism lenses and vision therapy can often reestablish comfortable single vision. Adjusting hand-eye coordination and working distances also helps adapt.
While strabismus requires ongoing management, people with a wandering eye can function and see well with some visual adaptations. And emerging treatments offer hope for improving eye alignment and vision.
What new treatments are being developed for strabismus?
Research is making progress developing less invasive and more targeted treatments to improve eye alignment:
- Eye drops – Medicated eye drops like low-dose atropine are being tested to gently realign the eyes in children.
- Low-level light therapy – Light applied to the eyes may modulate eye muscle growth and responsiveness.
- Botox injections – Local botulinum toxin injections can temporarily weaken extraocular muscles that pull the eye out of alignment.
- Adjustable sutures – Surgical incisions on eye muscles can be adjusted after surgery for fine realignment.
- 3D imaging – High resolution MRI and CT imaging better identifies abnormal eye muscle and nerve anatomy to target surgery.
Rather than sole reliance on eye patching and major surgery, these less invasive treatments aim to gently reshape vision development and eye alignment. More options may become available in the future.
Summary
While strabismus or a turned eye affects depth perception and eye teaming, early treatment can still allow good vision development in both eyes. With adaptations like eyeglasses and prisms, people with a wandering eye can see clearly, drive, and function normally.
Ongoing research is improving eye alignment treatments to preserve vision starting in infancy. So there is hope for further improving quality of life for people with strabismus through the latest medical advances.