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Symptoms & risk factors

In toddlers and children, strabismus is usually observed by parents, pediatricians, or teachers and caregivers. Even if the strabismus is only slightly noticeable or suspected, it is important that it is clarified. In all forms of strabismus, the two eyes do not work together ideally and there is a risk that three-dimensional vision (also called binocular vision) is compromised. Since vision development is not complete in children until they are about 10-(12) years old, this can cause them to be at risk for diminished vision, especially for the squinting eye. If adults squint newly in adulthood, they perceive double images. If children squint, they see double only at the beginning, after which they begin to suppress the perceived image of the squinting eye in order not to see double. In this way, children unconsciously neglect one eye with the consequence that the visual development of the squinting eye stops (which is called “amblyopia” in medical language). If the strabismus is diagnosed by the orthoptists and ophthalmologist, possible causes are clarified and treated accordingly. Often, glasses are necessary and a patching therapy.

Causes of strabismus in children

Most strabismus affects only the coordination of the eyes. Often, strabismus is related to uncorrected farsightedness, unilateral refractive error or disease of one eye. Among the more rare causes are developmental changes in the eye muscles. Very rarely, paralytic strabismus may also occur or, exceptionally rarely, a central cause (a brain disease) for strabismus may be present.

Forms of strabismus

Basically, a distinction is made between internal strabismus (eyes deviating towards the nose), external strabismus (eyes deviating outwards) and vertical strabismus (eyes deviating upwards or downwards).

Furthermore, a distinction is made between whether the strabismus is constantly observable, i.e. a always present or obvious strabismus (also called manifest strabismus) or whether it is only observed intermittently. The latter is referred to as intermittent strabismus. A latent (also called “hidden”) strabismus is often found, which is usually without pathological value.

In addition, there is the distinction whether it is a paralytic strabismus (i.e. an eye muscle or an eye muscle group is paralyzed) or an altered coordination between the eyes without a paralyzed eye muscle.

Latent strabismus

A latent strabismus, also called a hidden strabismus, usually has no clinical value. It is often detected during an eye examination, during which the cooperation of the eyes is closely examined.

Manifest strabismus

If a child is always squinting or if a strabismus is repeatedly observed by the relatives, it is very important that the strabismus is clarified as soon as possible. The cause of the strabismus should be determined so that an associated eye disease or neurological disease can be ruled out. The goal of treatment is to avoid neglecting the visual development of the affected eye in children. In the case of internal strabismus, and partly also external strabismus and paralytic strabismus, without treatment the child would unconsciously neglect the visual development of the squinting eye in order not to see double all the time: It suppresses one eye. Three-dimensional vision is thus also compromised without treatment. Depending on the form of strabismus, glasses and patching therapy may be necessary.

Paralytic strabismus

A paralytic strabismus is one of the rather rare strabismus forms. In this form of strabismus, a single eye muscle or a group of eye muscles is paralyzed. This means that depending on the direction of gaze, a different degree of strabismus is observed. There are various causes for this. These can be congenital or, rather rarely, related to a neurological disease. This form of strabismus requires special attention and a precise ophthalmological and neurological clarification.

Therapy of strabismus in children

In many cases, glasses are necessary to correct defective vision so that both eyes can develop the best possible visual acuity and to enable the eyes to coordinate as well as possible. Only eyes with good vision can coordinate with each other. Often one eye requires increased support, i.e. the stronger eye is patched in order to support the weaker eye (so-called amblyopia therapy). In the course of time, eye muscle surgery may be necessary to correct strabismus in order to achieve the best possible coordination between the eyes or to reduce the angle of strabismus.

Strabismus treatment is individualized according to the type of the strabismus and the needs of the children and their parents.


During an orthoptic examination, visual acuity, eye position, eye mobility, binocular vision and spatial vision (stereo vision) are examined. An orthoptic examination is particularly useful in cases of strabismus, eye movement disorders, double vision and children who wear glasses.

We offer orthoptic examinations for children and adults alike. Intermediate examinations are also performed directly by the orthoptists depending on the diagnosis, for example after spectacle adjustments with or without prism adjustments or during amblyopia therapy.

Strabismus treatment is individualized according to the type of the strabismus and the needs of the children and their parents.

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Office hours and appointment

We will be happy to arrange an appointment with you that suits you well in terms of time.

In case of emergency (especially in case of: sudden vision loss, acute pain or inflammation of the eyes, new strabismus, accidents) please call us so that we can give your children or you an urgent appointment.

Our office hours (consultation hours and telephone):

Monday - Friday
Monday - Friday
Saturday and Sunday

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