What it is
Strabismus is a condition where the eyes don't line up with each other. One eye can turn in (esotropia), out (exotropia), up (hypertropia), or down (hypotropia). The muscles that move the eye are usually fine — the problem is almost always how the brain controls them.
Strabismus can be constant or intermittent, can affect the same eye every time (unilateral) or switch between eyes (alternating). It's most often found in children, but adults can develop it too after physical trauma, a stroke, or from an untreated childhood misalignment that returns.
Signs parents notice
Things parents commonly notice:
- One eye pointing in a different direction — especially when the child is tired or focusing on something close
- Head tilting or turning to one side
- Closing or covering one eye in bright light, or when looking at something far away
- Complaints of double vision, headaches, or eye strain after reading
- Difficulty with reading or catching a ball — subtle depth-perception issues
Children under four months often have eyes that don't track perfectly together, and most of that resolves. If the misalignment is still present after four months, or if it looks severe, schedule an evaluation.
How we diagnose it
Any child over four months of age with suspected strabismus should see a pediatric ophthalmologist for a comprehensive exam. We check:
- Vision in each eye individually
- Eye alignment at near and distance, using light reflex and cover testing
- Ocular motility (how the eyes move in all directions)
- Refraction after dilating drops — farsightedness is a common underlying cause of esotropia
- The health of the back of the eye, to rule out anything more serious
How we treat it
Treatment depends on the type of strabismus and what's driving it:
- Glasses or contact lenses — often resolve the alignment if refractive error is the cause
- Patching — if there's associated amblyopia, improving vision in the weaker eye helps alignment too
- Prism lenses — bend light into the eye to ease double vision
- Eye drops, ointments, or targeted injections — can weaken an overactive muscle in select cases
- Orthoptic exercises — helpful for specific strabismus types, especially convergence insufficiency
- Strabismus surgery — Dr. Vredevoogd adjusts the length or position of the eye muscles so the eyes align. Surgery is usually outpatient and performed at a local hospital.
We talk through every option together and choose what fits your child. Surgery isn't the first step unless it clearly needs to be.
What the journey looks like
For most children, the first visit is a full diagnostic exam that takes 1–2 hours including dilation. After that, we'll have a clear picture of what's happening and a plan. If glasses alone are the answer, we can often fit them in the office that day at the optical shop.
If surgery is the right path, we schedule it at Zeeland Community Hospital, Spectrum Health, or Holland Hospital. Recovery is typically fast — kids are back to normal activity within a day or two, with follow-ups at one week and a month to check alignment.
Because strabismus can be a lifelong condition, most families stay with us for annual or semi-annual follow-up exams. You'll see Dr. V every visit — not a rotating roster.
When to call us
Call us right away if you notice any of these:
- A sudden new misalignment in a child of any age
- Double vision, in your child or yourself
- Eyes that don't track together consistently after four months of age
- An old strabismus that's come back, or seems to be getting worse
- An adult who develops strabismus after a head injury, stroke, or illness