GCEO Group®Understanding eye alignment
Eye movement depends on coordinated muscles and nerve signals. A turn may be inward, outward or vertical, and may be present constantly or appear intermittently.
[1]How the eyes may turn
Aligned eyes
Inward turn · Esotropia
Outward turn · Exotropia
Upward turn · Hypertropia
Downward turn · Hypotropia
How can it affect vision?
Misaligned eyes may send images that do not combine comfortably. Adults can experience double vision, difficulty judging depth or problems reading. Longstanding childhood strabismus may not cause double vision.
[3]Why can it develop?
Causes include a childhood eye turn, nerve palsies, thyroid eye disease, myasthenia gravis, injury or changes after eye surgery. Neurological causes include stroke.
[2]What might you notice?
- An eye drifting or appearing out of line.
- Double or blurred vision, eye discomfort or difficulty reading.
- Tilting or turning your head to see more comfortably.
What happens at an assessment?
An eye specialist checks the misalignment and its cause. Findings may warrant blood tests or scans. A strabismus specialist can discuss treatment.
[2]What treatments are available?
The choice depends on the type of turn, its cause and your symptoms. Your care team may discuss:
[2]Prism glasses
Prisms change the path of light and can relieve double vision in some people.
[3]Prescribed eye exercises
Exercises can help selected problems such as symptomatic convergence insufficiency, where the eyes struggle to work together at near. They are not a general solution for every eye turn.
[4]Botulinum toxin injections
In selected cases, injections alter the action of an eye muscle. Their benefit may be temporary.
[2]Eye-muscle surgery
Surgery changes a muscle’s position or length to improve alignment. It may involve one or both eyes, and selected patients may have adjustable stitches.
[5]Discuss benefits, risks and alternatives. Residual misalignment or double vision may remain, and further treatment can be needed.[2]
When should you seek urgent help?
- Seek urgent medical assessment for sudden double vision or double vision with eye pain.
- Get emergency help for double vision after a head injury, or blurred/double vision with a severe headache or a newly enlarged pupil.
Preparing for your appointment
Ask what is causing the turn, what each treatment aims to improve, and what follow-up you will need.
References and further reading
Useful next steps
Patient information supports discussion with your eye-care professional.