Strabismus in Infants

Newborn babies have very limited visual abilities. Over time, their sense of vision gradually develops. Just as a baby learns to speak by hearing, they develop the ability to see through visual experience during the first 8 years of life. Vision is a skill jointly developed by the eyes and the nervous system. Any eye problem in the newborn and early infancy period can disrupt this development. Strabismus (eye misalignment) is one of the most common causes.

Temporary eye deviations known as physiological strabismus can occur until babies reach 6 months of age. These are short-term and can happen in any direction. They are considered normal during the development of the nervous system. However, persistent or permanent deviations after 6 months are not normal.

Symptoms of Strabismus in Infants

Strabismus is the loss of alignment between the two eyes. It means the eyes cannot focus on the same point simultaneously. The deviation can be upward, downward, inward, or outward. It may affect one eye or both, appear intermittently or become permanent. Constant head tilting or frequent blinking may also be signs.

Regardless, all babies should be examined by an eye doctor at around 3–4 months of age, including a dilated eye examination.

Pseudo-Strabismus

Some babies may appear to have strabismus due to facial structure, especially the nasal bridge. This is not true strabismus and does not require treatment. An experienced ophthalmologist can easily distinguish it.

Causes of Strabismus

• Genetic factors are the most common cause.
• High refractive errors, especially hyperopia and unequal prescriptions.
• Congenital eye diseases such as cataract or glaucoma.
• Prematurity and low birth weight.
• Neurological or metabolic disorders.
• Birth trauma.
• High fever illnesses or seizures in early infancy.

Types and Onset

Eye misalignment can occur suddenly or gradually, affecting one or both eyes. It may be horizontal, vertical, or oblique depending on the underlying cause.

Treatment

Once diagnosed, treatment should begin as early as possible. Early treatment improves not only appearance but also visual function such as depth perception and prevents lazy eye.

The most common type is inward deviation due to hyperopia. Glasses and patching therapy may be sufficient. Some cases require surgery or Botox injections.

Surgery and Timing

Treatment should not be delayed. Waiting for the child to grow older can lead to permanent visual impairment.

Surgery is performed under general anesthesia and usually takes about one hour. The patient is discharged the same day.

Scarring and Stitchless Surgery

There is usually no visible scarring. Modern techniques use dissolvable sutures or tissue adhesives, improving comfort and recovery.

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