what causes wandering eye in adults

Adult Strabismus

• • A condition in which eyes wander to one side, cross, or are higher or lower than the other
• • Symptoms include double vision, which can start suddenly or gradually
• • Treatment includes placing prisms or opaque films in eyeglasses; surgery is also an option
• • Involves ophthalmology
• Strabismus (crossed eyes)
• Strabismus Surgery
• Optic Nerve Hypoplasia
• Pediatric Ophthalmology
• Hemiballismus

What are the symptoms of adult strabismus?

What are the most common types of strabismus, what causes adult strabismus, how is strabismus diagnosed, what are the treatment options for adult strabismus, what makes yale medicine’s approach to treating adult strabismus unique.

People who see second lines of print while they're working at their computer or see a car heading down their lane while they're driving may be suffering from strabismus, says  Martha Howard, MD , a surgeon at the Yale Medicine Pediatric Ophthalmology & Strabismus Program . "It can be very frightening,” says Dr. Howard.

Strabismus is a condition in which the eyes are not aligned. It affects people’s ability to function and can even cause them to lose their independence. Fortunately, in many situations, it’s also very treatable. Yale Medicine offers an array of strabismus specialists who have a deep knowledge of conditions, treatment and procedures.

An adult with strabismus will experience double vision. The onset can be sudden or gradual, says Dr. Howard. The distortion may occur only sometimes or in specific circumstances.

Strabismus may be intermittent at first and then become constant. “It may only happen when you look in a particular direction,” says Dr. Howard. “For some people, it may occur only when they are looking to one side."

Many times, the appearance will be obvious to outside observers. “But sometimes only family members or friends will notice that the eyes are not aligned,” Dr. Howard says.

Children with strabismus don’t see the second image because their brains suppress it. Adult brains don’t have that ability.

An estimated 4 percent of adults in the United States will experience strabismus in their lifetimes. The condition can be further described by the direction of the misalignment.

• Esotropia, the eyes cross inward
• Exotropia, one or both of the eyes look outward
• Hypertropia, one eye moves up out of alignment
• Hypotropia, one eye moves down out of alignment

Some adults with strabismus were born with the condition. It may have first appeared when they were children, but corrected itself as they matured. The risk of adult strabismus increases with age, so the condition can reappear when a person gets older.

“Unfortunately, as we age, our eye muscles do not function as well as they did in the past,” says Dr. Howard. “We call that decompensation.”

Such other health problems as circulation or neurological problems can lead to strabismus. Mini-strokes, diabetes and hypertension can impair the circulation to the muscle or to the nerves that control them. “Damage to different cranial nerves can cause strabismus and double vision,” Dr. Howard says.

Strabismus can occur in people with a history of thyroid disease, even if the thyroid blood levels are in control. Tumors in the brain stem or in the eye can cause strabismus as can trauma.

Diagnosing strabismus starts with a simple test: covering and uncovering each eye.

“When either eye is covered, the double vision resolves,” says Dr. Howard. “That’s a distinguishing feature. If you cover an eye and the double vision remains, that’s not strabismus.”

The ophthalmologist will perform a complete exam and check a patient’s ocular motility, which describes how well the eyes move in various directions. The physician will also measure the misalignment with prisms. “From that information, we can identify what kind of strabismus the patient has,” she says.

“In some situations, the double vision will resolve with time,” says Dr. Howard.

In some patients, strabismus can be improved by placing prisms in their glasses. In other cases, one eye must be covered with an opaque film over one lens of a person's glasses to eliminate the second image.

Surgery can play a significant role in improving the symptoms of strabismus. When necessary, surgery is usually performed with local anesthesia in an outpatient setting. However, general anesthesia is possible as well.

“I often use adjustable sutures,” says Dr. Howard. This allows post-surgery fine-tuning with topical (eye drop) anesthetics.

We have the only program for strabismus in southern New England located within an academic medical center. We are experts in diagnosing and treating strabismus disorders in adults. Our ophthalmologists understand the available options to improve symptoms of strabismus, including surgery if prisms become unwieldy.

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An Overview of Nystagmus

Why your eyes might "jump"

Nystagmus is an eye condition characterized by rapid, jerking eye movements. It does not always cause any noticeable symptoms, but it can be associated with issues such as dizziness and vision problems. A number of different neurological illnesses can cause nystagmus.

Typically, nystagmus is detected during a physical examination that involves an eye evaluation. It may be an early sign of a neurological condition, such as multiple sclerosis (MS) , or it can develop as an already established neurological illness progresses. You may need treatment to help reduce your nystagmus and/or the accompanying effects. Most of the time, medical or surgical management of the underlying cause is also necessary.

shaun / E+ / Getty Images 

Nystagmus typically affects both eyes, but rarely it can affect just one eye. The jerking movements are not usually present all the time, and nystagmus is often more noticeable when you are looking to one side or the other. In severe cases, eye jerking can be present all the time, even when you are looking straight ahead (not to the side).

Nystagmus looks like rapid, rhythmic, horizontal (side to side) motion of the eyes. Vertical (up and down) or rotary (moving in a circle) nystagmus can occur as well, but these patterns are not common.

Common symptoms of adult-acquired nystagmus (which differs from congenital nystagmus) include:

• Vertigo (a feeling that the room is spinning or that you are spinning)
• Diminished balance
• Nausea or vomiting
• Double or blurred vision
• Headaches, irritability
• A sense that visible objects are rhythmically jumping

You can experience all or some of these symptoms when you have nystagmus. Often, however, when nystagmus is present for a long time, the symptoms are not evident.

Sometimes nystagmus can be so severe that it affects your balance. Sudden episodes (such as when it is induced by twirling) can make you so dizzy that you could fall and get hurt.

Associated Symptoms 

If your nystagmus is caused by a neurological condition, you may also experience other effects. The associated symptoms are not necessarily caused by nystagmus and they do not cause nystagmus. Instead, they are usually caused by the illness that triggered nystagmus (such as a brain tumor).

Physical signs that may occur with nystagmus include:

• Weakness on one side of the body
• Numbness or diminished sensation on one side of the body
• Severely impaired balance
• Tremors (shaking or jerking of the body)
• Impaired coordination
• Vision deficits
• Droopy eyelids
• Memory loss or dementia
• Weight loss

If you have any signs of nystagmus, you need to get medical attention. The neurological issues that are commonly associated with eye jerking can progressively worsen if they are not treated.

Nystagmus is a symptom of some neurological illnesses and conditions that involve the inner ear. There are many neurological diseases that can be associated with eye jerking. Some of the conditions that cause nystagmus are serious and life-threatening, such as a brain tumor. Others are not associated with serious health risks, such as a lazy eye .

Common Risk Factors

The conditions that increase your risk of nystagmus do not always produce it. In fact, nystagmus is a relatively uncommon sign of neurological or inner ear disease.

Twirling : Twirling around in a circle for a few minutes and then stopping can cause a brief period of nystagmus that affects both eyes. This is generally harmless, but you may feel dizzy for minutes or even for the whole day afterward.

Strabismus (lazy eye) : A congenital (from birth) defect may cause the eyes to be misaligned. This can cause a visibly obvious effect described as a lazy eye. Sometimes, nystagmus can occur with a lazy eye, especially when you look to the extreme left or right.

Ménière’s disease : A condition characterized by episodes of severe vertigo and possible hearing loss, Ménière’s disease is often associated with rhythmic eye jerking, especially during the attacks.

Multiple sclerosis (MS) : This condition can cause various neurological symptoms because it can affect different areas of the brain , spinal cord , and/or optic nerve (the nerve that controls vision). MS may cause permanent or intermittent episodes of nystagmus in one or both eyes.

Brain tumor : A primary brain tumor (a tumor that starts in the brain) or a metastatic cancer from elsewhere in the body can invade or impinge on the cranial nerves , brainstem, or cerebellum in a manner that causes nystagmus to develop.

Labyrinthitis : Inflammation of the inner ear is described as labyrinthitis. It can occur due to an infection or inflammatory disease, or it may be idiopathic (without an identifiable cause). This condition can cause profound dizziness, nausea, and vomiting, and your eye examination may show nystagmus. Generally, labyrinthitis is characterized by severe symptoms, but it is not typically associated with serious or life-threatening health risks.

Stroke : An interruption in blood flow in the brain can cause brain damage. In rare instances, a stroke can result in nystagmus.

Paraneoplastic syndromes : Several types of cancer can produce antibodies (immune cells) that attack a person’s own body, causing paraneoplastic syndrome, a rare cancer side effect. Nystagmus is one of the common symptoms of paraneoplastic syndromes. Ovarian cancers and adrenal cancers are examples of cancers that may have this effect.

Congenital defect : Some children are born with nystagmus, and it may begin during infancy. The symptom can also occur during later childhood due to a hereditary condition. Childhood nystagmus can develop as a result of ocular albinism , an X-linked genetic disorder characterized by vision abnormalities and decreased pigment in the iris (the colored part of the eye around the pupil) of affected males.

Medications : Some medications can cause nystagmus as a side effect. Examples include Dilantin (phenytoin), Tegretol (carbamazepine), and barbiturates. These medications interfere with nerve function, and the nystagmus should wear off after the medication is metabolized from the body.

Alcohol : Alcohol intoxication can temporarily affect the nerves that control balance, resulting in coordination problems and nystagmus.

Trauma : A traumatic injury can cause damage to the brain, nerves, or muscles that control eye movement, resulting in nystagmus.

Control of Eye Movements 

There are a few areas of the brain and inner ear that are involved with coordinating eye movements. A permanent injury or temporary deficit involving any of these areas can interfere with normal eye movements, causing a number of potential vision and/or balance problems, including nystagmus.

Nystagmus can result from impairment of any of the following structures:

Cerebellum : The cerebellum is the region of your brain that controls balance. Damage to the cerebellum, such as from a tumor or stroke, may cause nystagmus. Additionally, the antibodies in paraneoplastic syndromes cause nystagmus by targeting the cerebellum.

Cranial nerves : There are three pairs of cranial nerves that control muscles of eye movement (each eye is controlled by one nerve of each pair). Damage to these nerves can interfere with eye muscles, causing nystagmus.

• The oculomotor nerve (cranial nerve three) controls several muscles that move your eyes: the superior rectus muscle, the medial rectus muscle, the inferior rectus muscle, and the inferior oblique muscle. These muscles move your eyes straight up and down and toward your nose.
• The trochlear nerve (cranial nerve four) controls the superior oblique muscle that moves your eye in a direction that is down and away from your nose.
• The abducens nerve (cranial nerve six) controls the lateral rectus muscle, which moves your eye outward and away from your nose.
• The vestibulocochlear nerve (cranial nerve eight) mediates your sense of sound and balance. It does not control eye movement, but a deficit in this nerve can impair balance to a degree that causes nystagmus.

Brainstem : The cranial nerve fibers and the nerve fibers of the cerebellum run though the brainstem, an area of the brain that links the brain with the spinal cord. For this reason, disease that involves the brainstem (such as a hemorrhage or stroke) may cause nystagmus.

Inner ear : The inner ear contains many tiny structures that control hearing and help mediate balance. Inflammation, infections, and tumors involving the inner ear can cause nystagmus.

Even if you have many of the associated symptoms, nystagmus is typically unnoticeable in day-to-day life. You are unlikely to notice your own jerky eye movements. It is very difficult to see your nystagmus in the mirror because the movements tend to be more intense when you look to the side. Sometimes, family or friends may notice your eyes jerking when they look at you.

Nystagmus is typically identified in a healthcare provider’s office during a medical examination. Your practitioner may check for nystagmus when doing a neurological examination during your yearly physical. Your eye muscles will be tested as you are asked to look toward each side with both eyes at the same time and hold your gaze for a few seconds. Your eye doctor would also notice nystagmus during a routine eye examination (such as for your glasses or contact lenses).

If you have nystagmus, your medical team will do further tests to identify the cause and see whether you have any worrisome complications.

Diagnostic examinations you may need include:

• Eye examination : There are several steps in an eye examination. Your healthcare provider will check your visual acuity (how well you can see close and faraway objects), usually with an eye chart. You will also have an examination that includes measuring the distance between your pupils. This test can assess any differences in eye movement between your eyes, and it can help identify a lazy eye. Your healthcare provider may measure the speed and direction of your eye movements, and this assessment can include a video of your eye movements.
• Brain imaging : Tests such as a brain computerized tomography (CT) or magnetic resonance imaging (MRI) can identify structural issues in the brain and inner ear such as tumors and strokes. These conditions can affect the function of the cerebellum, cranial nerves, or inner ear, resulting in nystagmus.
• Electronystagmography (ENG) : This diagnostic study is used to evaluate dizziness, vertigo, or nystagmus. ENG is a noninvasive test that objectively measures the function of your oculomotor and vestibular nerves, and it can help pinpoint whether one of these nerves is impaired.

There are several treatments used to help reduce the effects of nystagmus. Medications may be prescribed to specifically decrease the eye jerking movements. Sometimes, treatment is also needed to help lessen the associated nausea and dizziness.

Additionally, if you have a neurological condition causing you to have nystagmus, you may need to use rehabilitative therapy for management of your neurological disease.

Vision Correction

If a vision deficit is causing you to have nystagmus, you may need to use corrective lenses to help correct your vision. In some situations, surgical vision correction is considered the best option.

Control of Eye Jerking 

Prescriptions used to diminish nystagmus include oral Firdapse (amifampridine), Lioresal (baclofen), Klonopin (clonazepam), and Neurontin (gabapentin).   These medications may temporarily diminish your nystagmus, but they are not expected to cure it.

Symptomatic Therapies 

If dizziness, nausea, and/or vomiting are problematic for you, your healthcare provider might recommend over-the-counter or prescription therapy to help alleviate these effects.

Medical Management of Neurological Disease 

You may need to have medical therapy to treat the cause of your nystagmus. This can include disease-modifying therapy for management of MS, anti-inflammatory medication to manage Ménière’s disease, or antibiotics to treat an inner ear infection.

Botox (botulinum toxin) injections can be used to weaken and relax eye muscles. This is not the same as cosmetic botox, and it requires great care to avoid harming the eyes and the nearby structures.

Botulinum toxin weakens muscles, and when used for treatment of nystagmus, it reduces the compensatory nystagmus that occurs when the eye muscles are not of equal strength.

In some situations, eye surgery can repair muscle defects that are causing nystagmus. You may need treatment for a brain tumor or an inner ear tumor. Treatment approaches for a tumor include surgical removal, radiation therapy, and/or chemotherapy.

Rehabilitation 

Sometimes, therapy using rehabilitation techniques may be effective as a way to help strengthen your eye muscles. This can alleviate the problem if mild eye muscle weakness is the cause of your nystagmus.

A Word From Verywell

Nystagmus is often a symptom of neurological disease. If your eye jerking is causing discomfort, you may need to have it treated.

Sometimes nystagmus doesn’t cause any bothersome symptoms at all and can be discovered incidentally (by chance) when your healthcare provider is examining your eyes. There are times when nystagmus is the first clue that you have a neurological disorder. In these instances, you may need a thorough medical evaluation to identify the cause of your eye jerking. Treatment for the neurological conditions that cause nystagmus is usually necessary.

Eggers SDZ. Approach to the examination and classification of nystagmus . J Neurol Phys Ther. 2019;43 Suppl 2 Supplement, Special Supplement: International Conference on Vestibular Rehabilitation:S20-S26. doi:10.1097/NPT.0000000000000270

Kang S, Shaikh AG. Acquired pendular nystagmus . J Neurol Sci. 2017;375:8-17. doi:10.1016/j.jns.2017.01.033

Serra A, Chisari CG, Matta M. Eye movement abnormalities in multiple sclerosis: Pathogenesis, modeling, and treatment .  Front Neurol . 2018;9:31. doi:10.3389/fneur.2018.00031

Kruijt CC, De wit GC, Bergen AA, Florijn RJ, Schalij-delfos NE, Van genderen MM. The phenotypic spectrum of albinism . Ophthalmology. 2018;125(12):1953-1960. doi:10.1016/j.ophtha.2018.08.003

By Heidi Moawad, MD Dr. Moawad is a neurologist and expert in brain health. She regularly writes and edits health content for medical books and publications.

How to Take on Strabismus in Adults

Often mislabeled a childhood disease, strabismus can be treated in adults, with visual and psychosocial benefits., also by the authors, a new tack to rein in runaway awards, advancements in surgical microscopes, anti-vegf for cnv: questions remain, are you setting yourself up for burnout, ascs continue to move into the mainstream, better options emerging in ocular oncology, related articles, march 2014 wills eye resident case series - diagnosis & discussion, october 2015 wills eye resident diagnosis & discussion, wills eye residents case series - diagnosis and discussion, wills eye resident case series - diagnosis and discussion, april 2014 wills eye resident case series - diagnosis & discussion, current issue.

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Adult Strabismus (Eye Misalignment)

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Can anything be done for adults with strabismus (misaligned eyes)?

Yes. Adults can benefit from some of the same treatment options that are available to children for treating strabismus. Treatment options may include prismatic glasses, specialized exercises to regain the coordination of both eyes (fusional exercises) and surgery. Most adults with misaligned eyes are able to have successful realignment with surgery [See figure 1]. It is important consult with an eye surgeon who specializes in  strabismus surgery .

Why do adults get strabismus?

Adults may have misalignment either from a residual childhood strabismus or they may have new onset in adulthood. If the condition has been present since childhood, the misalignment may be suddenly noticeable, but there is usually no double vision.  In cases of misalignment suddenly occurring in adulthood, patients will almost always complain of double vision.  It is always important to evaluate the cause of the misalignment which may require blood tests or imaging studies like magnetic resonance imaging (MRI). New strabismus that develops in an adult can result from many diverse conditions including thyroid eye disease, stroke or tumors.  Sometimes, aging can cause a change in the soft tissue surrounding the eye that results in strabismus in the elderly, or there is no identifiable cause.

Is eye straightening as an adult strictly cosmetic?

No. Eye alignment surgery is performed in adults for several reasons. Adults frequently have disabling double vision because of eye misalignment. Surgery can often improve the double vision, depth perception and sometimes the field of peripheral vision.  If the prism correction needed to realign the eyes is large, the resulting glasses can be heavy, uncomfortable and can cause distorted vision.  Surgery can be considered to decrease the dependence on prism glasses.  Also,  strabismus  affects adults in emotional, social, and economical ways. Realigning the eyes can “reconstruct” the abnormal appearance of the eyes providing a better quality of life.

Does my insurance cover the expense of this surgery?

Eye muscle surgery is reconstructive (not cosmetic). In most cases, insurance will cover strabismus surgery in adults, however, one should check with their medical insurance carrier to determine coverage with their specific plan.

Fig. 1: Adult Strabismus, or misaligned eyes, can be surgically corrected.

Is eye muscle surgery risky for adults?

Every surgical procedure has some risks. For strabismus surgery, the most common risks are residual misalignment of the eyes and double vision. Most double vision that occurs after strabismus surgery is temporary; however, persistent double vision is possible. Fortunately, the more serious risks are rare. These risks include anesthetic complications, scarring on the white of the eye, infection, droopiness of the eyelids, bleeding, retinal detachment, and decreased vision. Health risks vary with the general health of the individual. For those in poor health, surgery under local anesthesia instead of general anesthesia may be considered.

How successful is eye muscle surgery?

Most individuals have significant improvement in eye alignment with one surgery. Occasionally the surgery is only partially successful, or changes in ocular alignment may occur over time after initially successful surgery. Additional surgery may be indicated. Correction of residual double vision may be improved with the use of prism glasses.

How painful is this type of surgery?

Discomfort after eye muscle surgery is usually not severe. A feeling of nausea can occur due to some of the medications used for anesthesia or from the surgery itself.  Resuming eating with bland foods can help in the recovery.  Most people are back on a normal diet the day following surgery.  Headache, pulling sensation with eye movement and foreign body sensation in the eye are the most common complaints. The eyes are often red following surgery as the muscle heals.  There may be mild swelling of the eyelids. These symptoms typically last only several days. Over-the-counter pain medication often reduces the discomfort, although stronger medication is sometimes prescribed. Ice compresses can also be helpful.  Most patients return to full activity in several days. Some surgeons limit swimming and heavy physical activity for a few weeks after surgery. 

Is hospitalization required for eye alignment surgery?

Eye alignment surgery  is usually performed as an outpatient procedure although the need for hospitalization varies depending upon general health and surgeon preference. This means that most people are released home a few hours following their surgery.  A trusted adult is needed to transport the patient home.  Most individuals return to nearly all normal activities within several days.

What age is considered "too old" to have eye muscle surgery?

Eyes can be straightened at any age and should be considered as a treatment option if it is likely to improve symptoms and enhance quality of life. In most cases, eye muscle surgery is a successful, safe, and effective treatment for strabismus in adults of all ages. The good news is that it is never too late for surgery. Even patients in their 90's have benefited from surgical correction.

I am embarrassed by my misaligned eyes and avoid looking people in the eye. It seems to me that people are distracted by my wandering eye, causing problems with social interaction and difficulty getting the job I want. Can this really be true?

Yes. Recent studies confirm these observations. Misaligned eyes can hinder social interaction, self-confidence and employment opportunities. All individuals deserve straight eyes if possible.

Who treats misaligned eyes in adults?

An ophthalmologist trained in strabismus is the most qualified specialist to treat adults with misaligned eyes. In determining the cause of the misalignment, other specialists may be utilized.  Adult strabismus specialists can be located in the directory of AAPOS, an organization of eye surgeons with special training in eye muscle problems. Your own eye doctor may also have a recommendation.

Many adults with strabismus wonder, "Why do I go to a pediatric eye specialist? I'm not a child anymore." The answer is that misaligned eyes are common in children and ophthalmologists who care for children tend to have the most expertise in treating eye muscle conditions.

Updated 12/2022

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Strabismus—Adult & Pediatric

What is strabismus.

Strabismus is a common eye-movement disorder where the eyes are not aligned correctly. Either one or both eyes may turn inward, outward, up, or down, which is why strabismus is also called wandering eye or cross eyes. In most cases strabismus is caused by abnormal neuromuscular control of eye movement. Strabismus can also be caused by poor muscle strength.

Find a Strabismus Doctor

Strabismus affects adults and children in different ways. Symptoms of strabismus in children are usually mild. Parents may notice that children tilt their head to one side to compensate or close and cover the deviating eye. Diagnosing this condition early is very important to reduce the loss of the child’s vision.

Adult Strabismus Symptoms

Symptoms of strabismus in adults may be more severe. Patients with this condition lose their binocular vision, which can cause double vision and loss of depth perception. As a result, patients may suffer from headaches or eye strain.

Treatment of strabismus may include any of the following:

• Putting a patch over the stronger eye to increase strength in the weaker eye
• Surgery to straighten the eyes
• Eye exercises

Lazy eye (amblyopia)

On this page, preparing for your appointment.

Your doctor will conduct an eye exam, checking for eye health, a wandering eye, a difference in vision between the eyes or poor vision in both eyes. Eyedrops are generally used to dilate the eyes. The eyedrops cause blurred vision that lasts for several hours or a day.

The method used to test vision depends on your child's age and stage of development:

• Preverbal children. A lighted magnifying device can be used to detect cataracts. Other tests can assess an infant's or toddler's ability to fix his or her gaze and to follow a moving object.
• Children age 3 and older. Tests using pictures or letters can assess the child's vision. Each eye is covered in turn to test the other.

It's important to start treatment for lazy eye as soon as possible in childhood, when the complicated connections between the eye and the brain are forming. The best results occur when treatment starts before age 7, although half of children between the ages of 7 and 17 respond to treatment.

Treatment options depend on the cause of lazy eye and on how much the condition is affecting your child's vision. Your doctor might recommend:

• Corrective eyewear. Glasses or contact lenses can correct problems such as nearsightedness, farsightedness or astigmatism that result in lazy eye.
• Eye patches. To stimulate the weaker eye, your child wears an eye patch over the eye with better vision for two to six or more hours a day. In rare cases, wearing an eye patch too long can cause amblyopia to develop in the patched eye. However it's usually reversible.
• Bangerter filter. This special filter is placed on the eyeglass lens of the stronger eye. The filter blurs the stronger eye and, like an eye patch, works to stimulate the weaker eye.
• Eyedrops. An eyedrop of a medication called atropine (Isopto Atropine) can temporarily blur vision in the stronger eye. Usually prescribed for use on weekends or daily, use of the drops encourages your child to use the weaker eye, and offers an alternative to a patch. Side effects include sensitivity to light and eye irritation.
• Surgery. Your child might need surgery if he or she has droopy eyelids or cataracts that cause deprivation amblyopia. If your child's eyes continue to cross or wander apart with the appropriate glasses, your doctor might recommend surgical repair to straighten the eyes, in addition to other lazy eye treatments.

Activity-based treatments — such as drawing, doing puzzles or playing computer games — are available. The effectiveness of adding these activities to other therapies hasn't been proved. Research into new treatments is ongoing.

For most children with lazy eye, proper treatment improves vision within weeks to months. Treatment might last from six months to two years.

It's important for your child to be monitored for recurrence of lazy eye — which can happen in up to 25 percent of children with the condition. If lazy eye recurs, treatment will need to start again.

Clinical trials

Explore Mayo Clinic studies  testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Your child's doctor might refer you to a doctor who specializes in treating eye disorders in children (pediatric ophthalmologist).

Here's some information to help you get ready.

What you can do

Make a list of the following:

• Symptoms, including any that may seem unrelated to the reason why you scheduled the appointment, and when you noticed them
• All medications, vitamins and supplements your child takes, including doses
• Key medical information, including other conditions or allergies your child has
• Your family history of eye problems, such as lazy eye, cataracts or glaucoma
• Questions to ask your doctor

For lazy eye, questions to ask your doctor include:

• What is the likely cause of my child's lazy eye?
• Is there another possible diagnosis?
• What treatment options are most likely to help my child?
• How much improvement can we expect with treatment?
• Is my child at risk of other complications from this condition?
• Is this condition likely to recur after treatment?
• How often should my child be seen for follow-up visits?

What to expect from your doctor

Your doctor is likely to ask you questions, such as:

• Does your child appear to have problems seeing?
• Do your child's eyes appear to cross or wander?
• Does your child hold things close to see them?
• Does your child squint?
• Have you noticed anything else unusual about your child's vision?
• Have your child's eyes been injured?

Aug 14, 2021

• Coats DK, et al. Amblyopia in children: Classification, screening, and evaluation. https://www.uptodate.com/contents/search. Accessed June 8, 2021.
• AskMayoExpert. Amblyopia. Mayo Clinic; 2021.
• Amblyopia. National Eye Institute. https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/amblyopia-lazy-eye. Accessed June 8, 2021.
• Amblyopia preferred practice pattern. American Academy of Ophthalmology. https://www.aao.org/preferred-practice-pattern/amblyopia-ppp-2017. Accessed June 8, 2021.
• Coats DK, et al. Amblyopia in children: Management and outcome. https://www.uptodate.com/contents/search. Accessed June 8, 2021.
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Amblyopia (Lazy Eye)

At a glance: Amblyopia

Poor vision in 1 eye

Eye drops or wearing an eye patch

What is amblyopia?

Amblyopia (also called lazy eye) i s a type of poor vision  that usually happens in just 1 eye but less commonly in both eyes. It develops when there’s a breakdown in how the brain and the eye work together, and the brain can’t recognize the sight from 1 eye. Over time, the brain relies more and more on the other, stronger eye — while vision in the weaker eye gets worse.

It’s called “lazy eye” because the stronger eye works better. But people with amblyopia are not lazy, and they can’t control the way their eyes work.

Amblyopia starts in childhood, and it’s the most common cause of vision loss in kids. Up to 3 out of 100 children have it. The good news is that early treatment works well and usually prevents long-term vision problems.

What are the symptoms of amblyopia?

Symptoms of amblyopia can be hard to notice. Kids with amblyopia may have poor depth perception — they have trouble telling how near or far something is. Parents may also notice signs that their child is struggling to see clearly, like:

• Shutting 1 eye
• Tilting their head

In many cases, parents don’t know their child has amblyopia until a doctor diagnoses it during an eye exam. That’s why it’s important for all kids to get a vision screening at least once between ages 3 and 5.

Is my child at risk for amblyopia?

Some kids are born with amblyopia and others develop it later in childhood. The chances of having amblyopia are higher in kids who:

• Were born early (premature)
• Were smaller than average at birth
• Have a family history of amblyopia, childhood cataracts, or other eye conditions
• Have developmental disabilities

What causes amblyopia?

In many cases, doctors don’t know the cause of amblyopia. But sometimes, a different vision problem can lead to amblyopia.

Normally, the brain uses nerve signals from both eyes to see. But if an eye condition makes vision in 1 eye worse, the brain may try to work around it. It starts to “turn off” signals from the weaker eye and rely only on the stronger eye.

Some eye conditions that can lead to amblyopia are:

• Refractive errors. These include common vision problems like nearsightedness (having trouble seeing far away), farsightedness (having trouble seeing things up close), and astigmatism (which can cause blurry vision). Normally, these problems are easy to fix with glasses or contacts. But if they’re not treated, the brain may start to rely more on the eye with stronger vision.
• Strabismus . Usually, the eyes move together as a pair. But in kids with strabismus, the eyes don’t line up. One eye might drift in, out, up, or down.
• Cataract. This causes cloudiness in the lens of the eye, making things look blurry. While most cataracts happen in older people, babies and children can also develop cataracts.

How will my child’s doctor check for amblyopia?

As part of a normal vision screening , your child’s doctor will look for signs of amblyopia. All kids ages 3 to 5 need to have their vision checked at least once.

What’s the treatment for amblyopia?

If there’s a vision problem causing amblyopia, the doctor may treat that first. For example, doctors may recommend glasses or contacts (for kids who are nearsighted or farsighted) or surgery (for kids with cataract).

The next step is to re-train the brain and force it to use the weaker eye. The more the brain uses it, the stronger it gets. Treatments include:

Wearing an eye patch on the stronger eye. By covering up this eye with a stick-on eye patch (similar to a Band-Aid), the brain has to use the weaker eye to see. Some kids only need to wear the patch for 2 hours a day, while others may need to wear it whenever they're awake.

Putting special eye drops in the stronger eye. A once-a-day drop of the drug atropine can temporarily blur near vision, which forces the brain to use the other eye. For some kids, this treatment works as well as an eye patch, and some parents find it easier to use (for example, because young children may try to pull off eye patches).

After your child starts treatment, their vision may start to get better within a few weeks. But it will probably take months to get the best results. After that, your child may still need to use these treatments from time to time to stop amblyopia from coming back.

It’s important to start treating children with amblyopia early — the sooner the better. Kids who grow up without treatment may have lifelong vision problems. Amblyopia treatment is usually less effective in adults than in children.

Last updated: September 22, 2022

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Pediatric Strabismus

Strabismus can develop at any time during childhood, but it most commonly develops between birth and age five. It's often caused by a problem with the muscles that move the eyes. Untreated, strabismus can impair depth perception. And if one eye becomes dominant, amblyopia, or poor vision, can also occur. 

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Our physicians also have expertise in diagnosing and treating all causes of adult strabismus. Treatments include prism therapy, Botox injections, and strabismus surgery. We often use an adjustable suture technique that allows us to adjust the muscle position (if needed) after surgery to help provide the best eye alignment and control of double vision.

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Adult Strabismus Treatment in Oklahoma City

What is adult strabismus.

Strabismus is the term used to describe any misalignment of the eyes in which the eyes fail to work in tandem to focus on and track objects correctly. While strabismus is a common pediatric eye condition , it can also affect adults, causing them to experience somewhat different symptoms and unique problems as compared to younger patients. Dean McGee Eye Institute diagnoses and treats patients with adult strabismus. With strabismus, when one eye is focused straight ahead, the other will turn in, out, up, or down. For adults, this turning can cause double vision, inability to localize objects, loss of depth perception, and other debilitating visual problems. The appearance of the misaligned eye can also negatively impact a person’s emotional well-being and social interactions. DMEI offers multiple treatment options for adult strabismus. In most cases, insurance carriers will cover strabismus treatment because it is considered medically necessary. If you have concerns about adult strabismus, we encourage you to call 405.271.6060 or 800.787.9012 today to request an appointment with one of our adult strabismus doctors .

What Causes Double Vision & Adult Strabismus?

Strabismus occurs when there is an abnormality in the muscles or nerves associated with eye movement or with their connection to the brain. While it is not always possible to identify the origin of strabismus, some common causes of strabismus in adults include:

• Childhood strabismus that was not corrected or has recurred.
• Various Neurological Conditions
• Thyroid Eye Disease
• The Aging Process

What Are the Symptoms of Adult Strabismus?

The classic indicator of strabismus is the visible turning of an eye (although sometimes the misalignment is small enough that it is not cosmetically visible). Children with strabismus often experience less direct visual disturbance because their brains can ignore visual input from the turned eye. Adults with strabismus often experience additional symptoms, including:

• Double-Vision (Diplopia) – Seeing two images of the same object when there should only be one
• Visual Confusion – Seeing two different images superimposed onto each other.
• Image Jump – Images captured in the field of view change significantly as focus shifts from one eye to the other.
• Abnormal Head Posture – Adults with strabismus often turn their faces or tilt their heads to compensate for double vision.
• Loss of Depth Perception – This may result in problems with hand-eye coordination, driving or parking a car, or various athletic activities.

How Is Adult Strabismus Diagnosed?

A comprehensive eye examination is needed to diagnose adult strabismus. We’ll evaluate your symptoms and your eye movements to determine your diagnosis. Our experienced DMEI qualified eye doctors can properly diagnose and treat your type of strabismus.

Treatments for Adult Strabismus

There are different approaches to treating adult strabismus depending on its cause and severity, but they all have the same goal of restoring binocular vision. Treatment options include:

• The use of a prism in eyeglasses to correct double vision
• Eye exercises (orthoptics)
• Injections of botulinum toxin ( Botox )
• Appropriate eye glasses or contact lens prescription

Adult Strabismus Surgery

Surgery might be recommended if the misalignment cannot be corrected using other methods. During strabismus surgery, the eyelids are held open by a lid speculum. Your surgeon gains access to the eye muscles by making a small incision in the conjunctiva, the thin layer of transparent tissue covering the white part of the eye. The eye muscles may be strengthened, weakened, repositioned or otherwise altered depending on your particular needs and the judgment of your surgeon. At no point is the eyeball removed. Surgery is usually performed on an outpatient basis, and most patients return to regular activity within a week.

In some cases, a surgeon will use an adjustable suture technique in which a temporary knot is used. This knot is left accessible so that the surgeon can use it to adjust eye alignment after surgery. Such adjusting is usually done while the patient is awake and can be performed within a day after surgery. The use of adjustable sutures can increase the ability of the surgeon to achieve correct alignment and may decrease the need to perform muscle surgery on that eye again. Some patients may be required to continue other treatment protocols, such as glasses or exercises, after strabismus surgery, and some may need additional surgeries.

Amblyopia vs. Strabismus

Many people confuse strabismus with amblyopia, or lazy eye . Strabismus simply refers to the misalignment of the eyes, whatever the cause. Amblyopia means the brain has not developed the ability to see images clearly in one or both eyes. Amblyopia patients don’t achieve complete visual clarity, and while glasses or contact lenses can help, they won’t restore perfectly normal vision. Strabismus is a common cause of amblyopia due to the brain ignoring visual signals from the misaligned eye. The brain essentially suppresses information from one or both eyes, causing a lazy eye.

Adult Strabismus Doctors at the Dean McGee Eye Institute

It takes specially-trained physicians to treat adult strabismus effectively. Since strabismus is much more common in children, pediatric ophthalmologists have significant experience treating it and often treat adult strabismus. In addition, neuro-ophthalmologists, with their expertise in the neuro-muscular systems of the eye , also regularly treat strabismus. At the Dean McGee Eye Institute, we have the only practice in the region with a team composed of both types of ophthalmologists. If you’re suffering from double vision, crossed eyes, or have other symptoms of strabismus, contact us today. Visit our online directory of providers who treat adult strabismus to learn more about our team, or call 405.271.1091 or 800.787.9013 to request your appointment today.

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You do not have to suffer from strabismus in silence. Whatever your age or the severity of your condition, we want to help! Visit our online directory of providers who treat adult strabismus to learn more about our team. Give us a call to schedule your appointment today. We look forward to serving your vision needs!

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What causes adult amblyopia and what is the treatment?

I'm 25 years old and have been told I have symptoms of amblyopia in my right eye. I'm confused as I thought it was generally a pediatric disorder. What may have caused this and what is the treatment?

Amblyopia is a general term meaning impaired vision.

Amblyopia ex anopsia is visual loss in children, which, if not treated at an early age, becomes permanent. Children do not complain of it and adults usually are unaware of its presence unless they cover one eye or have an eye test, general physical exam, driver's license exam, etc. The eyes themselves are normal to examination but fail to develop normal vision because they are not stimulated in early childhood. This can occur because of a drooping eyelid , cataract or tumor blocking the entry of light into the eye, a large difference in refractive error (need for eyeglass correction) between the two eyes, or strabismus (failure of the two eyes to align on the same target simultaneously). In the latter case, the brain initially sees double, which is annoying, and learns to suppress one image for comfort. The net result is that the vision loss eventually becomes permanent.

Treatment is directed to the cause and may be surgical removal of the obstruction, correction of the drooping eyelid, cataract surgery , eyeglasses , contact lenses , etc. The earlier the treatment is begun, the faster the correction. Often the child has to wear an eye patch on the GOOD eye, or use eye drops to blur it, forcing use of the eye with the decreased vision. We used to believe that this treatment had to be done by age seven years, but often can work in older children. Pleoptics and flashing light treatments have no proven value. Laser vision correction has been used to correct the refractive errors, but patching is still necessary.

The important message here is that no child is too young to have an eye examination, and parents should consult an ophthalmologist promptly if they notice or suspect anything or if there is a family history of amblyopia. This question was originally answered on Sept. 5, 2012.

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Our ophthalmologists have answered thousands of questions about eye diseases and conditions. Search our entire Ask an Ophthalmologist collection to find the answers you need. Read our important medical disclaimer . You can also browse by topic to see how physicians answered questions about a specific eye condition:

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Wandering Eye

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A wandering eye is a type of eye condition known as strabismus or tropia, and it may be caused by damage to the retina or muscles that control the eye, stroke or brain injury, or an uncorrected refractive error like farsightedness. With a wandering eye, one eye deviates or wanders in a different direction when looking at an object.

What Causes a Wandering Eye?

The eyes contain muscles to which they are attached to, and these muscles receive signals from the brain that direct eye movement. Normally, the eyes work together so that they focus in the same direction at the same time. However, with a wandering eye, there is poor eye muscle control and one eye turns away from the object that the person is attempting to hone in on—either up, down, in or out. The eye that turns may do so all the time, or it may only do so at certain times, such as when the person is fatigued, sick or has overworked the eyes as a result of prolonged reading or staring at a computer. There are other cases where the eyes may alternate turning.

Because the eyes are misaligned, the brain receives a different image from each eye. While the brain will learn to ignore the image it gets from the wandering eye, if left untreated, lazy eye or amblyopia can present. This is characterized by a permanent reduction of vision in the traveling eye, and can lead to poor depth perception.

A wandering eye can be classified by the direction the eye turns:

• Inward (esotropia)
• Outward (exotropia)
• Downward (hypotropia)
• Upward (hypertropia)

It may also be classified in other ways:

• Alternating (the eye that turns alternates from left to right)
• Unilateral (always involves the same eye)
• Constant or intermittent (the regularity with which it occurs)

Testing and Treatment

To determine the classification, and in order to develop a treatment plan for a wandering eye, an optometrist will look at a number of factors to understand the cause of the condition, as well as how the eyes move and focus. This may include:

• Looking at the patient’s  family history
• Reviewing the patient’s  medical history
• Observing the external and internal structures  of the turned eye
• Refraction  – a string of lenses are put in front of the patient’s eyes and a handheld instrument with a light source is waved pass. This is done to gauge how the eyes focus and can conclude the lens power needed to correct refractive errors like nearsightedness, astigmatism and farsightedness.
• Visual acuity  – reading letters on distance or near reading charts to measure and estimate the amount of visual impairment
• Focusing and alignment testing   to determine how well your eyes move, focus and work together.

Information gathered from these assessments will help your optometrist devise a treatment plan, which could consist of vision therapy, eyeglasses, prism or eye muscle surgery. If treated early, a wandering eye can be corrected and vision can be restored.

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Exotropia (Outward Turning Eyes)

In this article

Exotropia refers to a type of strabismus (eye misalignment) in which either one or both of the eyes turn outward.

It’s not the same as esotropia . In this condition, either one or both of the eyes turn inward. 

Exotropia is a common condition. It accounts for 25 percent of all ocular misalignment cases in young children. 3

While it could happen periodically, it could also be constant. However, it is more typical to find exotropia developed while a child is 1 to 4 years old.

Parents may notice this form of strabismus, especially when the child is:

• Daydreaming
• Tired 

It may also be apparent when the child attempts to focus on distant objects. When a child focuses on items up close, it may be difficult to notice the eye condition. 

If there is suspicion of exotropia, it is essential to seek an eye care specialist. An eye doctor can perform a comprehensive eye exam and differential diagnosis to rule out other possible conditions. 

Signs & Symptoms of Exotropia

Those with exotropia may experience some symptoms of exotropia or show signs.

For example, they may have:

• Loss of binocular vision
• Loss of depth perception
• Outward turning of the eyes. This can begin as intermittent
• Sensitivity to bright light or bright sunlight (this can cause people to squint) 

These symptoms do not always suggest exotropia. However, it is essential to seek an eye consultation if one or more of these symptoms are present. 

Different Types of Exotropia

There are 4 types of exotropia.

Speak with your ophthalmologist and undergo an eye exam to see which type of exotropia you or your child has.  

1. Sensory Exotropia

If a person has sensory exotropia, the eye may suffer from poor vision or blindness. It will also turn outward. 

Initially, if an infant or young child has a blind or poorly seeing eye, esotropia develops. However, in older children, the eye often becomes exotropic. These children are usually between the ages of 2 and 4 years.

2. Intermittent Exotropia

With intermittent exotropia, one eye turns outward on occasions.

Other times, the eyes are straight. During these times, there is no apparent suggestion of the condition. Family members or friends may observe the exotropia when the person with the disorder is either tired or daydreaming. 

Intermittent exotropia may be more noticeable when the person looks at distant objects. 

This type of exotropia is rare and will cause no to few symptoms. However, intermittent exotropia can occur more often or progress to becoming constant. 

3. Congenital Exotropia

Some may refer to congenital exotropia as infantile exotropia. This outward turning of the eyes is present since birth or during early infancy. 

While esotropia is more common in infants, a pediatric ophthalmologist should assess constant exotropia. The latter condition may link with an underlying medical condition. 

4. Alternating Exotropia 

People with an alternating exotropia have an outward eye turn that alternates both eyes. The condition can be constant or intermittent. It varies in degree of severity. 

Intermittent exotropia is the most frequent type of strabismus. The condition impacts as much as 1 percent of the U.S. population. 8 It is more common in females than in males. 

Potential Complications of Exotropia

Exotropia can cause complications, including:

• Trouble reading 
• Blurry vision
• Decreased 3D vision
• Abnormal head posture

More than 90 percent of children with intermittent exotropia develop myopia by 20 years of age. 1

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What Causes Exotropia?

There is no specific, known cause of exotropia. 

It may be common in children with either sensory exotropia or an underlying genetic disorder that affects eye movements. 

Here is a list of some eye diseases that could increase the likelihood of developing exotropia:

• Duane’s syndrome —  this is a congenital strabismus syndrome. People with the condition may experience diplopia (double vision), anisometropia (the two eyes have different refractive errors), and amblyopia (lazy eye). 
• Slipped or lost medial rectus muscle — loss of this muscle can happen after different types of eye surgery. These eye surgeries include retinal detachment surgery or paranasal sinus surgery. 
• Internuclear ophthalmoplegia — this is an ocular motility disorder. This condition affects the lateral gaze and causes ophthalmoplegia . This is paralysis or weakness of the eye muscles. 
• Orbital fibrosis — this rare condition is characterized by an infiltrating orbital mass and thickening of connective tissue. 

Additionally, these risk factors may increase the probability of exotropia:

• Family history of strabismus, amblyopia, childhood cataract, or glaucoma (increased eye pressure) 
• Some genetic disorders. For example, cerebral palsy or Down syndrome 
• Childhood cataracts or glaucoma

It is essential to understand that exotropia is not a disease in and of itself. The condition refers to a motility disturbance. This disturbance includes abnormal eye movements or trouble managing eye movements.

Exotropia can occur as a result of a particular medical disease or disorder. 

How is Exotropia Diagnosed?

An eye doctor, such as an ophthalmologist or optometrist, will perform an exotropia diagnosis based on:

• Family history
• Vision testing 

Vision tests can consist of:

• Reading letters from an eye chart 
• Refraction to test for uncorrected refractive error. In these cases, glasses may be prescribed
• Eye drops that dilate the pupils of the eyes and enable an exam of the eye’s internal structures

Treatment Options for Exotropia

Those with exotropia can explore both non-surgical and surgical treatment options. 

Non-surgical treatment possibilities include:

• Patching 
• Over-minused spectacles or glasses
• Orthoptic therapy. These exercises enable the re-education of binocular vision
• Prism glasses 

Surgical treatments may be performed to maintain or restore binocular capability. Diplopia refers to double vision, while cosmesis means to enhance physical appearance.

There is a higher success rate in the long run for those with intermittent exotropia and with stronger binocular function at the time of surgery. 

To learn which treatment is most suitable, you should visit your local eye clinic. There you can speak with a professional eye care specialist.

Is it Possible to Outgrow Intermittent Exotropia?

Intermittent exotropia may occur in infants as young as 1 to 2 months of age. If the condition is mild, it may go away on its own within 6 to 8 weeks of birth. 

In other cases of exotropia, it is not common to find a complete resolution of the condition.

Patching, glasses, or vision therapy can help. However, exotropia may remain present. 

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Understanding Esotropia: Types, Causes, Symptoms & Treatment

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Surgical & Non-Surgical Treatments for Lazy Eye

Why Does My Eye Hurt When I Blink? Causes & Treatments

Burning Eyes: Symptoms, Causes, and More

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Vision Therapy for Adults

Can adults benefit from vision therapy?

Do you feel like your work performance is impacted by constant headaches or eye strain?

Are you finding it difficult to meet deadlines? 

What is vision therapy?

Vision therapy is a remarkably effective program that improves vision skills to achieve clearer and more comfortable vision.

Through a series of progressive therapeutic eye exercises, patients develop normal visual skills. Enhancement of the visual skills is achieved by improving the communication between your brain and your eyes.

Vision therapy can be best understood as gym for the brain!

Vision therapy is designed as an individual and personalized treatment program, often used in conjunction with other treatments such as eyeglasses or eye surgery. Vision therapy is performed under the supervision of an eye doctor and performed once per week in sessions lasting 30-45 minutes.

Home practice is given to reinforce exercises learned during in-office therapy sessions. Commitment to weekly sessions and therapy homework assignments are essential for optimal results.

Is vision therapy effective for adults?

YES. Vision therapy is often just as effective for adults as it is for children.

Adults can succeed with vision therapy as well as children, due to neuro-plasticity . Neuroplasticity enables your brain to remain dynamic and flexible throughout your life.

Additionally, adults are usually highly motivated to improve their visual skills— this gives them the energy to push through any difficult obstacles. Visual function training used in vision therapy can be compared to learning a trade or playing an instrument— the more you practice or train, the stronger and more skillful you will become.

Vision therapy can treat a variety of vision conditions:

• Strabismus (eye turn)
• Amblyopia (lazy eye)
• Convergence insufficiency (eye teaming)
• Saccadic dysfunction (eye tracking)
• Traumatic brain injury (concussion)

How does a lazy eye affect vision?

Amblyopia, commonly known as a “lazy eye” is a neuro-developmental vision condition. Lazy eye develops when one eye is unable to achieve normal visual acuity, causing blurry vision in the affected eye, even with corrective eyewear.  The condition also commonly presents with poor depth perception, and reading difficulties.

According to research, amblyopia affects up to 1 in 33 of the population— this means up to 10 million people in the USA may have a lazy eye!

What causes a lazy eye? 

Lazy eye is diagnosed when the neural connections between the lazy eye and the brain have been affected. A healthy eye-brain connection can be compared to a multi-lane highway— the eye sends visual signals to the brain to be interpreted, and the brain sends signals back to the eye to enable clear vision.

However, in the case of amblyopia, the “highway” does not work as a multi-lane road due to a disconnect in the visual pathways. Therefore, the connection between the brain and the lazy eye may be similar to a one-lane street, or even a walking track.

Vision conditions that may cause lazy eye

• Isometropia is a significantly high, but equal optical prescription in both eyes.
• Anisometropia is a significant difference in eyeglass prescription (i.e. nearsightedness, farsightedness, astigmatism) between the two eyes.
• Constant strabismus is a constant noticeable turn of one eye in any direction. An inward turn of the eye (Esotropia) is the most common.  Amblyopia resulting from strabismus can be easier to detect because the noticeable eye turn alerts to a vision problem.
• Ocular obstruction can result from any physical blockage of vision, such as a cataract, trauma, lid droop (ptosis), or blocked tear duct.

A lazy eye can develop as a result of the conditions listed above, however the true underlying cause of lazy eye is a reaction in the brain, called suppression.

Suppression occurs when the brain actively ignores all of the visual information coming from one eye to avoid blurry or double vision (diplopia) .  Suppression can cause serious consequences, and can lead to an eye turn, also known as strabismus.

Do I have a lazy eye?

It may be difficult to recognize a lazy eye because the condition usually develops in one eye, and may not present with a noticeable eye turn.

It is therefore important to schedule an eye exam if you notice any of the following signs and symptoms.

• Shutting one eye or squinting
• Rubbing eyes often
• Poor eye-hand coordination
• Accident prone
• Poor depth perception
• Difficulty with fine eye movements
• Reduced reading speed and comprehension
• Poor eye focusing skills
• Inability to follow an object with just the eyes
• A cross-eyed appearance
• Unusual eye movements such as flickering or blinking

Schedule an appointment with a vision therapy eye doctor to help improve your visual skills.

SEE RELATED: Vision Therapy for Adults: Success Stories

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Is vision therapy effective in treating adults with lazy eye.

Yes! Vision therapy has been shown to greatly improve the visual skills of the lazy eye by re-training the visual system.

Recent studies have shown that the neural pathways of the brain can be enhanced at any age—this means that a lazy eye can actually be treated at any age, even into adulthood.

Vision therapy for adults can be very effective, but might take longer to achieve the optimum results. Of course, the earlier the condition is diagnosed the better the outcome usually is.

For many decades, it has been thought that amblyopia (lazy eye) can only be treated for children up to around ages seven to nine years— meaning that lazy eye treatment was usually not provided to children older than nine.

However, recent research from the National Eye Institute (NEI) shows that a lazy eye can be successfully treated at least up to age 17 .

The NEI research was conducted at 49 eye centers across the U.S., including the Bascom Palmer Eye Institute, Mayo Clinic, The Emory Eye Center, The Ohio State University, Southern California College of Optometry, and the State University of New York, College of Optometry.

The study includes 507 children between the ages 7-17, and found that it is possible to improve eyesight even in children up to age 17.

Results showed:

• 53 percent of 7 to 12 year-olds had improved vision following treatment!
• 47 percent of 13 to 17 year old children also gained improved eyesight!

Through vision therapy, the two eyes will be trained to work together to achieve clear and comfortable binocular vision.

Some vision therapy programs to treat amblyopia may include:

• Accommodation (focusing)
• Fixation (visual gaze)
• Saccades (switching eye focus, “eye jumps”)
• Pursuits (eye tracking)
• Spatial skills (eye-hand coordination)
• Stereopsis (3-D vision)

Can adults have convergence insufficiency?

Yes . Convergence insufficiency (CI) is a highly treatable binocular vision condition that can affect adults. 

Convergence insufficiency affects near vision and eye muscle coordination. Convergence of the eyes occurs when the two eyes need to focus on a close object, such as a book, computer, tablet, smartphone, etc. Convergence insufficiency means the eyes struggle to focus for near tasks, affecting work performance and attention to tasks.

What are the symptoms of CI?

There are many different symptoms that can develop as a result of CI— these are the most common:

• Headaches or muscle tension
• Blurred or double vision
• Difficulty reading and concentrating
• Uses finger or ruler when reading
• Avoidance of close work
• Poor hand-eye coordination
• Motion sickness/dizziness

If you have CI, the following tasks may be challenging:

• Computer work
• Comprehension

Untreated CI can lead to avoidance behaviors such as reading and close work, or the use of various strategies to combat symptoms, such as using a ruler or finger to keep one’s place while reading or taking frequent breaks.

Can CI cause visual suppression?

If untreated, convergence insufficiency can lead to more serious eye problems such as lazy eye (amblyopia) or even an eye turn (strabismus).

If the convergence problems are left untreated, suppression can result. Suppression of vision in one eye occurs when the brain actively shuts off one eye, causing loss of binocular (two-eyed) vision and depth perception.

In this case, some or all of the following symptoms may present:

• Trouble catching balls and other objects thrown through the air
• Avoidance of sports and games that require accurate depth perception
• Trips and stumbles on uneven surfaces, stairs, and curbs
• Frequent spilling or knocking over of objects
• Bumping into doors, furniture and other stationary objects
• Sports accidents
• Avoidance of eye contact
• Poor posture while doing activities requiring near vision
• Frequent head tilt
• Problems with motion sickness and/or vertigo

Is vision therapy effective for treating adults with CI?

Yes! Vision therapy is the most effective treatment for CI.

Standard eyeglasses, contact lenses, medications, and surgery will not be effective in treating the condition.

Treatments for CI can be categorized as active or passive:

Active treatment : A multi-site randomized clinical trial funded by the National Eye Institute called the Convergence Insufficiency Treatment Trial showed that the best treatment for CI is supervised vision therapy in a clinical office with home reinforcement (15 minutes of prescribed vision exercises done in the home five days per week).

Passive treatment : Prismatic (prism) eyeglasses can be prescribed to decrease some of the symptoms.

• Although prism eyeglasses can relieve symptoms, they are not a “cure” and the patient typically remains dependent on the prism lenses.
• Adaptation problems can lead to the need for stronger prescriptions in the future.

In many cases, prisms are prescribed in combination with vision therapy. Vision therapy focuses on training the eyes to work together to improve 3-D vision, depth perception, and clear binocular vision.

Treatment exercises for CI may include:

• Eye tracking with pursuits and saccades
• Focusing for near and distance
• Depth perception practice
• Specialized equipment and tools such as prisms and lenses
• Training with computerized technology

The goal of vision therapy is to stimulate the communication between the brain and eyes, to enable clear and comfortable vision at all times.

Adults and eye turns (strabismus)

How does strabismus affect vision.

Strabismus occurs when the two eyes are unable to maintain proper alignment and focus together on an object— one eye looks directly at the object, while the other eye points in a different direction.

Strabismus is often referred to as, ‘crossed eyed’, ‘wall eyed’, an ‘eye turn’,  or a ‘squint’.

The eye turn may be:

• Inward (esotropia, or ‘cross-eyed’)
• Outward (exotropia or ‘wall-eyed’)
• Upward (hypertropia)
• Downward (hypotropia)

The condition can be a constant or intermittent problem, and may consistently affect the same eye (unilateral) or affect a different eye each time (alternating).

Up to 5 percent of the population has some type of strabismus. 

Strabismus does not go away on its own— but it is usually treatable.

What causes strabismus?

Strabismus that affects adults can develop in adults may be caused by:

• Severe farsightedness (hyperopia)
• Lazy eye (amblyopia)
• Significant difference of optical prescription between the two eyes
• An ocular muscle weakness (eye movement problems)
• Head trauma or stroke
• Brain tumors or other systemic health issues

What are the signs and symptoms of strabismus?

Strabismus may initially cause double vision that can be quite uncomfortable.  To prevent double vision, the brain begins to actively ignore visual input from the affected eye, often resulting in amblyopia (lazy eye) or an eye turn, where the eyes are no longer aligned.

The most common sign of strabismus is noticeable misalignment of the eyes , where one eye is turned up, down, in, or out when compared to the other.

Other symptoms can include:

• Double vision
• Reading difficulty or fatigue

Is vision therapy effective for treating adults with strabismus?

Yes! Vision therapy is highly effective for the treatment of strabismus.

A vision therapy program for strabismus will include improvement of:

• Eye alignment
• Eye teaming
• Eye focusing
• Eye movements
• Binocular vision
• Visual processing

Therapeutic lenses, prisms, and filters may be used as part of a vision therapy program.  Vision therapy not only involves ocular muscle training, it also includes training and development of the eye-brain connections (neuroplasticity) required for clear and comfortable vision— resulting in a lasting cure.

Sometimes, a program of vision therapy may be recommended by your eye doctor after strabismus surgery in order to re-train the visual system.

It is important to treat strabismus as early as possible, as the eye turn may be a result of a serious health issue.

If you have an untreated vision problem you may be experiencing difficulty at home, at work, and even during sports activities. There is no need to continue suffering! 

LEARN MORE: Guide to Vision Therapy for Adults

Schedule an eye exam and vision evaluation for a proper diagnosis, and to discuss if a vision therapy program is the appropriate treatment for you .

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Lazy Eye: Causes and Treatment

If you or your child has a lazy eye ( amblyopia ), one eye is sending unclear images to the brain. while both eyes can be affected, usually amblyopia affects just one eye, with the brain relying on the stronger eye for visual information.

A lazy eye, which some people are born with, is the primary source of vision loss in kids, but adults with vision trouble in one of their eyes also can develop lazy eye later in life.

This article will discuss the causes of lazy eye, vision problems it causes, diagnosis, treatment, and management.

How Do You Get Lazy Eye?

Lazy eye can develop anytime an eye is not functioning properly and fails to send sharp images to the brain. It is most common in young children. The condition affects up to 3 out of 100 children. Typically this happens in the following instances:

• If one eye over the other is much more nearsighted (able to see near objects more clearly than distant objects) or farsighted (able to see distant objects more clearly than near objects), the brain will begin to ignore the eye sending the fuzzier signals.
• In cases of strabismus , a condition in which the eyes focus on different images, such as if one eye wanders to the side instead of looking straight ahead, the brain will have to choose which eye to rely on for information. It then begins to ignore the other.
• If the normally clear lens (the structure that focuses light on the retina) develops a cataract (a clouding of the lens), after a while, the brain will tune out signals from the eye and will potentially never see normally.

These eye conditions are more likely to occur in some people than others. Those at risk for developing a lazy eye include children who were premature at birth or had a low birth weight and those who come from families where someone else has amblyopia.

Treatment: Can You "Fix" a Lazy Eye?

Effectively treating a lazy eye means first understanding what's causing it while aiming to correct the vision in the weaker eye. Treatment is particularly effective in children under the age 7 whose vision is still developing. Some treatments to consider include:

• Wear glasses to sharpen vision, particularly in the weaker eye.
• Put a patch over the stronger eye several hours a day to allow the brain to begin to rely on the weaker eye.
• Temporarily blur vision in the stronger eye with atropine drops .
• Surgically correct things interfering with vision, such as a drooping eyelid or a cataract .
• Watch videos wearing a virtual reality headset to strengthen the weaker eye (in children ages 4 to 7).
• Perform eye exercises to strengthen the weak eye .
• Undergo muscle surgery to allow the eyes to work better together.

Eye doctors, such as ophthalmologists, encourage early treatment. Seek treatment even if the lazy eye is not discovered until later or there is some other obstacle. Don't consider it to be too late.

Research suggests that even adults can potentially improve their vision. Although it was once believed that the vision center of the adult brain could not hold on to any new experiences or information, research has shown that this is not true, and it is possible to improve vision somewhat.

Identifying Lazy Eye

It helps to know the symptoms of lazy eye to be able to identify it in your child or yourself. Symptoms can be subtle and include:

• A tendency to shut one eye
• Tilting the head to see better
• Squinting to see more clearly
• Eyes that appear to be working on their own rather than together
• Eyes that are inwardly or outwardly turned
• Trouble with depth perception
• Decreased vision in one eye

Because signs in children may be subtle and difficult to discern, it's important to take children between the ages of 3 and 5 for regular vision screenings.

The cause of lazy eye will determine whether and when surgery is needed. For instance, if an infant has a dense cataract, surgery will need to be performed right away. But if the child is older and the cataract is just a small dot, the eye doctor may try other measures first, like patching the eye that doesn't have the cataract.

For children with strabismus (depending on their age), the eye surgeon may want to perform eye muscle surgery as early as possible. Those under age 4 tend to have better outcomes than older children.

While strabismus surgery typically ranges from $5,000 to $10,000 out of pocket, much of the cost usually is covered by insurance.

Vision Problems With Lazy Eye

If children with lazy eye are treated early enough (before age 5), they tend to recover fully, with no lingering vision problems. But if treatment is delayed, the child may have problems with depth perception . Those over age 10 may only recover some vision with treatment and may have some permanent vision loss in the affected eye.

Keep in mind that the impairment in the eye can be mild, with vision in the 20/30 range, or severe, leaving the child legally blind in the eye with 20/200 vision.

Amblyopia Daily Management

In many cases, amblyopia is managed daily with treatments like using drops or patching the stronger eye for a period of time.

If patching is used, you'll initially be asked to cover the stronger eye for about two hours daily. The eye doctor will then monitor vision every six to 12 weeks. If there is not enough improvement, you or your child will be asked to wear the patch up to six hours daily.

Getting a child to keep a patch on can be challenging but is of utmost importance. Some strategies to try if a child resists include the following:

• Rewarding the child for using the patch with computer, device, or TV time
• Motivating them with stickers on a patching chart or diary for hours when the patch is worn

The use of atropine drops is an alternative to patching. Each day a drop is placed in the stronger eye to widen the pupil . It then forces the other eye to be used for close-up tasks like reading.

Also, each day you can encourage your child to perform eye exercises to strengthen the weaker eye, such as the following:

• Viewing dots
• Coloring within the lines
• Playing computer games
• Following an object like a lollipop stick
• Viewing stereograms (a two-dimensional image that can cause an optical illusion if viewed in a certain way)
• Eye relaxation

These can be fun exercises for your child and work to alleviate lazy eye.

Amblyopia (lazy eye) usually affects one eye. With this, the brain begins to rely on vision signals from the stronger eye and ignore those from the weaker, "lazy" one. Reasons why a lazy eye may develop include a cataract, which makes it difficult to see out of the eye; strabismus, in which the eyes are focusing on different points; and a difference in refractive error, in which one eye sees better than the other.

Treatment ranges from patching the stronger eye or blurring with drops, to surgery to remove any obstruction that may cause the vision to be unclear, such as a cataract or drooping lid.

'They get confused': Eclipse could cause anxiety for patients with dementia or Alzheimer's

The total solar eclipse Monday afternoon may cause confusion and anxiety for patients with dementia or Alzheimer's disease.

The sudden darkness will activate behavioral changes known as sundowning that many older adults experience every evening, said Pam Myers, one of the Alzheimer's Association's senior program directors for Ohio.

"As it gets dark out and goes from late afternoon to early evening, people living with dementia sometimes will become more confused," Myers said. "A person living with dementia can get confused and agitated and distracted because of the change of going from light to darkness. It can be very disorienting for people."

'It could be very unsettling'

Ohio skies will begin to darken around 2 p.m. Monday. Totality will hit western Ohio about 3:10 p.m. and head northeast, reaching Cleveland by 3:15 p.m.

Totality will last nearly 4 minutes. During that time, the sky will be completely dark, as if it were nighttime.

And the darkness will be guaranteed, despite Monday's weather. Even people in areas where it's too cloudy to see the eclipse will know it's happening because the sky above the clouds will go dark.

"It could be very unsettling because part of sundowning is a rhythm," Myers said. "It pretty much happens at the same time every day, so this is going to be a different time of day. It's going to be earlier in the day. Then the person may be more confused when it becomes light out again."

'They'll start pacing or they'll start wandering'

Sundowning tends to affect people with dementia or Alzheimer's about the time everyone else is getting home from work and making dinner.

"They get confused," Myers said. "What day is it? What time is it? They might ask that several times."

Some patients develop anxiety and become restless.

"They'll get up and they'll start pacing or they'll start wandering, start looking for something," Myers said. "They might say, 'I need to go home, I need to go home.' It's anxiety and confusion."

That behavior is expected by caregivers and close family members every night, and is often secluded from neighbors or extended family. During the solar eclipse Monday, though, it might be a little more visible.

"Over 80% of people with dementia live at home," Myers said.

'Talk to them in a slow, calm voice'

Anyone who provides care for someone with dementia or Alzheimer's is advised to make sure they sleep well and get plenty to eat in the final days before the eclipse.

Those known to display greater sundowning symptoms should probably be kept at home during the eclipse.

"This is not somebody that you want to have put the glasses on and go outside," Myers said. "Keep them to their routine."

She suggests keeping the patient's area brightly lit Monday afternoon. Since dementia and Alzheimer's do not reduce a person's ability to appreciate music, playing some of their favorite albums may help keep them calm.

Many patients may understand there's an eclipse, but some will not.

"Depending on where your person is, are you able to talk to them about what's coming?" Myers said. "Some people you have conversations with, they won't remember. That's part of the disease. Whatever you do, try to decrease anxiety, and keep them well rested."

Older adults who live at home may be outside or even in public when their sundowning symptoms begin Monday afternoon.

"People just need to be aware that they may see some sundowning behavior," Myers said.

Neighbors could see someone wandering around their backyard for no apparent reason, or strangers could find someone walking around in public.

"Talk to them in a slow, calm voice," Myers said. "Try not to ask them too many questions. It's more having a calm approach. Ask them if there's something you can help them with."

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