Mild Eye Deviation (Strabismus) in Children: Causes, Symptoms, and Treatment

Mild eye deviation in children, often referred to as strabismus or astigmatism depending on the exact condition, is fairly common. When it comes to children, however, parents naturally worry about their physical and emotional well-being. It’s important to understand that what many parents call “eye deviation” may be due to an abnormal shape of the cornea—the clear, dome-shaped outer surface at the front of the eye. An irregularly shaped cornea prevents light from focusing properly, causing blurred vision at both near and far distances.

Early diagnosis of corneal irregularities and refractive errors in children greatly improves treatment outcomes. If treatment is delayed, the child starts to strain and focus excessively just to see clearly, which can lead to headaches, eye fatigue, general tiredness, and even poor school performance.

Strabismus is also a common condition in childhood. It occurs when the eyes are not aligned properly and point in different directions. One eye may look straight ahead while the other turns inward, outward, upward, or downward, and the misalignment may alternate between the two eyes.

According to the American Optometric Association (AOA), children should have their first eye exam at 6 months of age, then at 3 years, and again before starting school at around 5–6 years. Most eye conditions in children are treatable. Refractive errors and misalignment (strabismus) are among the most common. Early intervention improves visual function, reduces complications, and prevents worsening of the condition as the child grows.

What Is Eye Deviation (Astigmatism) in Children?

Astigmatism is a type of refractive error caused by an irregular curvature of the eye, usually the cornea or sometimes the lens. Normally, the cornea has a smooth, evenly curved dome-like shape. With astigmatism, the cornea or lens is more curved in one direction than another, more like a football than a basketball. This irregular curvature prevents light from focusing sharply on the retina, causing blurred or distorted vision.

In this sense, astigmatism in children is not a “disease” in itself but a refractive error—an issue with how light is bent and focused inside the eye. The cornea is simply unable to bring light to a single, clear focus on the retina.

Mild astigmatism can be present from birth and may become more noticeable around the age of one year. Children who already have other refractive errors—such as nearsightedness (myopia) or farsightedness (hyperopia)—are at higher risk of also developing astigmatism.

Mild Eye Deviation (Strabismus) in Children

Strabismus (eye deviation or “crossed eyes”) occurs when the eyes do not line up in the same direction at the same time. One or both of your child’s eyes may turn:

– Inward (esotropia)

– Outward (exotropia)

– Upward (hypertropia)

– Downward (hypotropia)

A child can be born with strabismus (congenital) or develop it later in childhood.

Causes of Sudden Eye Deviation in Children

The underlying cause of eye deviation or astigmatism is what ultimately guides treatment. Around 23% of infants are diagnosed with astigmatism between 6 and 12 months of age. The irregular, non-spherical shape of the cornea or the lens is a description of the condition, not the root cause.

Several factors can increase a child’s risk of developing eye deviation or astigmatism, including:

– Family history of refractive errors or strabismus  

– Congenital (present at birth) corneal or lens irregularities  

– Premature birth or low birth weight  

– Certain systemic or neurological conditions  

Symptoms of Eye Deviation (Astigmatism) in Children

It can be challenging to detect the signs of astigmatism or other refractive errors in infants and toddlers because they cannot describe what they see. Regular pediatric and eye exams are therefore essential for early detection.

Parents should pay close attention to behaviors that may suggest a refractive error, such as:

Light Sensitivity (Photophobia)

When suddenly exposed to bright light, some children quickly turn their heads away or squeeze their eyes shut. Because their eyes cannot focus light properly or adapt comfortably, they may see scattered light and flashes instead of clear images, making it difficult to concentrate. If your child seems unusually sensitive to light and cries when exposed to it, this may be a sign of a corneal refractive problem such as astigmatism.

Covering One Eye or Squinting with Both Eyes

Some children instinctively cover one eye with their hand, thinking it will help them see more clearly, or they may squint with both eyes to reduce blur and improve focus. If you notice your child doing this while watching television, looking at books, or focusing on distant objects, it may indicate an underlying refractive error or strabismus.

Eye Rubbing

Frequent eye rubbing is often a sign of eye strain. A child with uncorrected refractive error exerts extra effort to see clearly, which causes fatigue and discomfort. Persistent rubbing can irritate the eye and the surrounding tissues and may be associated with several vision problems. While you should gently discourage your child from rubbing their eyes, this behavior is a strong signal that an eye exam is needed.

Sitting Too Close to the TV or Holding Books Very Near

If your child consistently sits very close to the television, holds tablets or picture books very near to their face, or leans in excessively to see, it may indicate that their visual field is not clear at a normal distance. By moving closer, they try to reduce the amount of scattered light reaching the eye and compensate for blurred vision.

Frequent Headaches

Unexplained or recurrent headaches, especially after tasks that require visual focus (such as reading, screen time, or schoolwork), can be a sign of eye strain caused by uncorrected astigmatism or other refractive errors. Younger children may only express this by crying or touching their head.

Corneal Irregularity in Children

Children may be born with strabismus or develop it later in infancy or early childhood. In many cases, the problem lies in the muscles that move the eyes, or in the nerve signals that control those muscles, and there is often a family tendency.

Most children with strabismus are diagnosed between the ages of 1 and 4 years. In rare cases, strabismus can appear after age 6. When strabismus develops suddenly after that age, it’s important for the child to see an eye doctor (often a pediatric ophthalmologist) promptly to rule out other neurological or ocular conditions.

Treatment of Eye Deviation (Astigmatism/Strabismus) in Children

To determine the best treatment plan for what parents call “mild eye deviation” in infants or children, a comprehensive eye exam by an eye specialist is essential. Treatment options for eye deviation and refractive errors in children include:

– Prescription eyeglasses  

– Contact lenses in selected older children  

– Patching therapy (for amblyopia or “lazy eye”)  

– Eye drops to blur the stronger eye (penalization therapy)  

– Vision therapy in some cases  

– Surgical correction of eye muscle alignment when needed  

In cases of mild astigmatism in preschool-aged children, the doctor may decide that immediate treatment is not necessary and monitor the condition until school age. Once the child starts school, appropriate prescription glasses are often recommended to correct the refractive error and prevent eye strain and learning difficulties.

Surgical options may be considered when the main problem is eye misalignment (strabismus) rather than simple refractive error. Surgery is not usually the first-line treatment and is decided based on several factors, including:

– Type and severity of strabismus  

– Response to glasses or other conservative treatments  

– Age of the child  

– Overall eye health and corneal thickness (for refractive surgery later in life)  

Laser refractive surgery (such as LASIK) is used in adults and sometimes older adolescents to correct refractive errors like astigmatism, but it is generally not performed in very young children because their eyes are still growing and changing.

Strabismus surgery, on the other hand, is commonly performed in children to realign the eyes. It is usually done in an outpatient eye surgery center under general anesthesia. The ophthalmologist makes a small incision in the conjunctiva (the thin tissue covering the white of the eye) to access the eye muscles, then adjusts (tightens or loosens) one or more muscles so that the eyes point in the same direction. This may be done in one or both eyes, and some children may require a second operation for optimal alignment.

Most children can return to their normal daily activities within about 2–3 days after surgery. As with any surgical procedure, there are risks, though serious complications are rare. The pediatric ophthalmologist will discuss the benefits and possible risks in detail.

Strabismus surgery is generally a safe and effective way to correct eye misalignment. However, it does not replace the need for glasses, patching, or penalization therapy if these are also recommended. Strengthening the weaker eye and ensuring both eyes work together is crucial for achieving and maintaining good vision.

Treatment of Mild Strabismus in Children

In some cases, mild strabismus can be managed successfully with glasses alone. If a child is significantly farsighted or nearsighted, the constant effort to focus can cause the eyes to cross or drift. Corrective lenses relax this effort and may straighten the eyes without surgery.

In other situations, the eye doctor may prescribe:

– An eye patch over the stronger eye to force the weaker eye to work harder  

– Atropine or other eye drops to blur vision in the stronger eye, again encouraging use of the weaker eye  

These approaches help strengthen the weaker eye and support better alignment. When glasses and conservative measures are not enough to straighten the eyes, eye muscle surgery may be necessary.

As described above, pediatric ophthalmologists are specially trained to perform strabismus surgery safely and effectively in children. The procedure is typically done under general anesthesia. After a small incision is made in the conjunctiva, the surgeon locates the extraocular muscles, then weakens or tightens them as needed:

– To weaken a muscle, it may be moved back (recessed) so it pulls less  

– To strengthen a muscle, it may be shortened or advanced so it pulls more  

This can be done in one or both eyes. Some children may need more than one surgery to achieve the best alignment.

Most children resume normal activities within 2–3 days. As with any surgery, there are potential risks that, while uncommon, can be serious; these will be explained by the ophthalmologist. Strabismus surgery is generally a safe and effective treatment for eye misalignment, but it does not replace glasses, patching, or other prescribed therapies.

Causes of Corneal Distortion in Children

Certain corneal diseases can cause progressive thinning and bulging of the cornea, leading to irregular astigmatism, such as:

– Keratoconus  

– Pellucid marginal degeneration  

Both conditions produce an irregular corneal surface, though the pattern and location of thinning differ between them. They usually require specialized management and close monitoring by a cornea specialist.

Degrees of Astigmatism in Children

Astigmatism is measured in diopters (D). An eye with no astigmatism has 0.00 diopters of cylinder power. Many people, including children, have a small amount of physiological astigmatism, often between 0.50 and 0.75 diopters, which may not cause significant symptoms.

Higher levels of astigmatism are more likely to cause blurred or distorted vision and may require corrective lenses.

How Do I Know if My Child Has Eye Deviation?

It is normal for newborns’ eyes to occasionally wander or appear slightly crossed during the first few months of life while their visual system is still developing. By about 4–6 months of age, the eyes usually become consistently aligned.

If one or both eyes continue to drift inward, outward, upward, or downward beyond 4–6 months of age—even intermittently—this may indicate true strabismus and should be evaluated by an eye doctor.

Causes of Eye Deviation in Infants

Infants can be born with strabismus or develop it in early childhood. Common contributing factors include:

– Imbalance in the eye muscles that control eye movement  

– Abnormal nerve signals from the brain to the eye muscles  

– Significant refractive errors (especially uncorrected farsightedness)  

– Family history of strabismus or other eye conditions  

Most children with strabismus are diagnosed between 1 and 4 years of age.

Why Do the Eyes Deviate When Focusing?

Eye misalignment can have many causes, and sometimes the exact reason is unknown. Possible causes and contributing conditions include:

– Significant farsightedness (hyperopia), leading to excessive focusing effort  

– Thyroid eye disease (Graves’ ophthalmopathy)  

– Cataracts  

– Eye injuries or trauma  

– Myasthenia gravis (a neuromuscular disorder)  

– Cranial nerve palsies affecting the eye muscles  

– Brain disorders or complications around the time of birth in some patients  

Any new or sudden eye deviation—especially in an older child—warrants prompt medical evaluation.

Treatment of Strabismus in 2-Year-Old Children

Treatment for strabismus around age two often includes:

– Correcting refractive errors with glasses  

– Treating amblyopia (lazy eye) with patching or penalization  

– Using glasses with prism lenses in selected cases  

– Surgical alignment of the eye muscles when needed  

Strabismus occurs in about 3% of children. If left untreated, approximately half of those children may develop amblyopia, a permanent reduction in vision in one eye due to poor visual development. Early diagnosis and treatment are critical to prevent long-term vision loss.

Is Eye Deviation Hereditary?

More than 350 eye diseases and conditions have a genetic component, including:

– Color blindness  

– Amblyopia (lazy eye)  

– Myopia (nearsightedness)  

– Hyperopia (farsightedness)  

– Various forms of strabismus  

Children can be born with strabismus or develop it in early childhood, and it often runs in families. A strong family history makes regular eye exams for children even more important.

Eye Deviation (Astigmatism) Testing

Your child’s pediatrician will routinely screen eye health at well-child visits. A more formal vision screening or eye exam is recommended before the age of one when possible.

During an eye assessment, the provider may:

– Inspect the external structures and basic eye movements  

– Check the red reflex and light reflex for symmetry  

– Use age-appropriate vision tests (pictures, matching games, letter charts)  

– Use specialized tools to estimate refractive error and detect strabismus  

Because your child’s vision changes as they grow, periodic eye and vision screening—at least every two years after the first full eye exam—is important, or more often if a problem has been identified.

Can Eye Deviation Disappear in Children?

As mentioned earlier, about 23% of infants show astigmatism detected in the first year of life. As the child grows and their eyes develop, the cornea may partially “remodel” itself, and the refractive error can lessen or even disappear.

By around 5–6 years of age, only about 9% of children still have clinically significant astigmatism. For this reason, many doctors manage mild astigmatism in very young children with observation and glasses when needed, without rushing into more invasive options before age six.

However, parents should not rely solely on the possibility of spontaneous improvement. Regular follow-up, monitoring symptoms, and tracking changes in visual behavior are essential to protect the child from complications.

Delaying treatment can lead to amblyopia (lazy eye). Even if the astigmatism does not resolve after age six, it does not usually cause serious long-term problems provided it is properly corrected and monitored. With appropriate care, children with astigmatism or strabismus can enjoy normal vision and development.

Seeking evaluation and treatment in a specialized eye center that uses modern diagnostic and therapeutic technologies is a wise choice to address eye deviation in children effectively.

How Does Mild Eye Deviation Affect a Child’s Vision?

With normal binocular vision, both eyes are aligned on the same target. The brain fuses the two slightly different images into a single three-dimensional (3D) image, which allows us to judge depth and distance (depth perception).

When one eye is misaligned, two different images are sent to the brain. In a young child, the brain adapts by suppressing (ignoring) the image from the deviated eye and relying only on the image from the straight or better-seeing eye. Over time, this can:

– Reduce or eliminate depth perception  

– Lead to amblyopia (lazy eye) in the misaligned eye  

Adults who develop strabismus after childhood are more likely to experience double vision (diplopia) because their brains have already learned to use both eyes together and cannot easily suppress one image.

Pseudo-Strabismus (False Eye Deviation) in Infants

In infants under one year of age, the eyes may appear crossed even when they are actually well aligned. This is called “pseudo-strabismus” or “pseudo-crossed eyes.”

It commonly occurs in babies who have:

– A broad or flat nasal bridge  

– Prominent skin folds at the inner corners of the eyelids (epicanthal folds)  

These facial features can create the illusion that the eyes are turned inward. In pseudo-strabismus, the corneal light reflex (the reflection of light on the surface of the eyes) is symmetric in both eyes, indicating proper alignment.

Children can outgrow pseudo-strabismus as their facial features change. However, true strabismus does not resolve on its own and requires evaluation and management.

Frequently Asked Questions

Does eye deviation (astigmatism or strabismus) have a cure?

In many cases, yes. Refractive errors like astigmatism can usually be corrected effectively with glasses or contact lenses, and in older patients with suitable eye health, with refractive surgery. Strabismus can often be treated with glasses, patching, and/or surgery. Early diagnosis and individualized treatment are key.

When is eye deviation considered dangerous?

Any persistent eye misalignment after 4–6 months of age, sudden onset of strabismus, or associated symptoms such as double vision, headache, or neurological signs should be evaluated urgently. Children with any form of strabismus should be examined as early as possible by an eye specialist to rule out serious underlying causes and prevent permanent vision loss (amblyopia). Sometimes, a child’s eyes may appear normal until age 3 or 4, then suddenly begin to cross or drift, which also requires prompt evaluation.

Can eye deviation return to normal on its own?

Some mild refractive errors and pseudo-strabismus can improve as the child grows. However, true strabismus and clinically significant refractive errors usually need active treatment. Intermittent exotropia (eyes drifting outward occasionally) is a form of strabismus that may appear only during certain activities, such as daydreaming or focusing at a distance. While not typically life-threatening, it should be evaluated and managed to prevent visual problems and social or cosmetic concerns.

Does eye deviation worsen if glasses are not worn?

Not wearing prescribed glasses does not necessarily make the refractive error itself (the number in diopters) worse in a mechanical sense, but it can cause:

– Constant eye strain and discomfort  

– Frequent headaches, often on one side of the head  

– Difficulty concentrating and reduced school performance  

– Increased risk of amblyopia if one eye is significantly weaker  

So while the prescription may not always “increase” because of not wearing glasses, the functional impact on the child’s vision, comfort, and development can be significant.

How does a person with astigmatism see?

Astigmatism is a refractive error that affects how the eye bends light. Instead of focusing light to a single sharp point on the retina, light is spread over multiple points, causing blurred or distorted vision. Objects at any distance may appear fuzzy, ghosted, or stretched. Most people have a small degree of astigmatism, but the severity varies widely.

Does eye deviation get worse over time?

Any visual complaint—whether due to refractive error, corneal irregularity, or strabismus—should be evaluated by a qualified eye specialist. Some conditions are stable, while others can progress. Accurate diagnosis, regular follow-up, and appropriate treatment using modern diagnostic tools and therapeutic techniques are essential to preserve and optimize vision.