Everything You Need To Know About Strabismus

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Strabismus (Half-past four eyes)

Tell me if this sounds familiar.

You walk up to or get introduced to a person at school or some social gathering.

But when you make eye contact, you notice that one of the person’s eye is looking straight at you and the other is looking elsewhere.

Quite disturbing, right?

A few minutes into the conversation, the person realizes that you have noticed their condition…

You try to act like you haven’t noticed but it’s too late. They already know that you know.

Things start to get a little awkward.

You probably don’t want the situation to get anymore awkward, and so you try to minimize eye contact while talking with the person.

You look at your phone or stare into empty space as you talk, just so you don’t make eye contact.

Then finally, you come up with some excuse to end the meeting and run.

Or, perhaps…

You are the one in the picture who has the condition.

That condition is called Strabismus.

Strabismus is a misalignment of the eyes where both eyes point in different directions.

While one eye may point straight, the other eye points in another direction. It could be outward (divergent squint), inward (convergent squint), or upwards/downwards (vertical squint).

This condition can happen in one eye (unilateral strabismus) or alternate between the two eyes (alternating strabismus). It can be intermittent or constant.

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Your eyes are supposed to work together. When they focus on an object, an image is captured by both eyes and sent to the brain. The brain then reconciles both images together as one which prevents you from seeing double.

Strabismus is a common eye condition. It is commonly known as crossed eyes, cross-eye or wall-eyed. In Nigeria, it is commonly called half-past four or quarter past four eyes. This condition can affect any one or both eyes at the same time.

Statistically, 1 out of every 20 children has strabismus. Dozens of researches suggest that about a third of the world’s population have this condition.

That’s about 210 million people!

Causes of Strabismus

When you have a neurological or anatomical defect that messes with the normal control and function of your eye muscles, it results in strabismus.

The defect could be from the eye muscles, the nerves, or the vision centres in your brain that control how your eyes work together.

Strabismus is hereditary. If any of your parents or grandparents had strabismus, chances are you got it from them. Your kids may have a high risk of developing the condition as well.

You could also develop strabismus when your eyes try to overcome certain vision problems like short- or long-sightedness.

There are many cases where the cause of the squint is not known.

Did you know that some babies are born with strabismus? This is largely as a result of incomplete vision development. It usually corrects itself as the child grows.

But where it did not, the child could be accessed later in life by a behavioural optometrist or vision therapist to find the possible causes and remedy. 

Signs and Symptoms of Strabismus

Strabismus (quarter past four) is easy to identify. If you have strabismus, one of your eyes looks straight ahead, while the other looks the other way.

Remember how I said your eyes are supposed to work together? That doesn’t happen when you have got strabismus. Because both of your eyes do not convey the same information to your brain.

As this happens, your brain disregards the image from the misaligned eye and instead, keeps the image from the ’straight’ eye. This leads to a condition called amblyopia in the misaligned eye. Amblyopia is commonly known as “lazy eye”.

Effects of Strabismus

Strabismus can occur in two ways. It can either be largely visible and obvious called large-angle strabismus. Or slight and less noticeable called small-angle strabismus.

Small-angle strabismus can cause symptoms that may affect your daily activities. These symptoms include:

  • inability to read comfortably,
  • severe eye strain,
  • headaches,
  • shaky or unstable vision,
  • Reading fatigue,
  • poor performance in school and sports.

They are as a result of your brain fighting to straighten the affected eye to align with the normal one. If it affects one eye and is constant, it will eventually lead to “lazy eye”.

Large-angle strabismus can lead to severe amblyopia or “lazy eye” in the affected eye if left untreated. It can cause your head to be positioned abnormally without you knowing it.

What’s more?

Strabismus can be damaging psychologically.

It can severely affect social interaction as you may find it embarrassing to hold people’s gaze. This in turn could affect your self-esteem.

Low self-esteem is quite common in children and young adults with strabismus. In Nigeria, they are often stigmatized with tags like ‘half-past four eyes’, ‘quarter-past four eyes’, or ‘four o’clock eyes.

If you have strabismus, you may have been laughed at or mocked in school or social gatherings a few times. Many people may find it disturbing to make eye contact with you. And this may keep you from attending social functions or meeting people.

Treatment for Strabismus

Whether the cause of your strabismus is known or not, it can be treated. Sadly, there are people who go through life not knowing their squint can be corrected.

You should get your kid(s) treated as soon as you notice they have strabismus. It is best to start treatment at young age to prevent conditions such as “Lazy eye” or amblyopia from occurring.

Starting early also helps children to perform better at school and sports. It improves their social interactions with their peers.

There are 2 major treatments for strabismus:

  1. Surgical Treatment
After Strabismus surgery

The most common treatment for strabismus is corrective surgery. This surgery is usually done by an ophthalmologist who is a specialist in strabismus surgery.

Your eyeballs move with the help of strong muscles attached to the front of the eyeballs. Strabismus surgery entails tightening or moving one or more of these muscles in order to move the eye to the proper position.

It is important that surgical treatment be considered early on when strabismus is discovered, especially in children. This is because the earlier it is done, the higher the chances are that the eyes will work together.

Even though strabismus surgery is an effective treatment, it is not without flaws. For instance, in many cases, there remains a significant degree of lazy eye (amblyopia) after the surgery.

You would also have to consider that the surgery may not be successful at first; that you may require more than one surgery to properly align your eyes. Factors such as the degree and direction of the misalignment could affect the success of the surgery.

Plus, after each surgery you may be given medication to deal with the pain. You may have to stay off work or school till the pain and redness goes away. This would take several weeks and you may also have double vision in that recovery period.

Surgeries of any kind are not without risks of complication. Even though this is rare, it is possible in strabismus surgery.

You may need to consider that surgeries are quite expensive. And if you cannot afford it, you may continue to live with strabismus.

But you don’t have to…

There is a less expensive, risk-free, and highly effective treatment for strabismus.

And that is…

  • Vision Therapy
Before and After Vision Therapy

Vision therapy is an eye-brain physical therapy; it basically teaches the brain to work with your eyes.

While other forms of treatments like surgery may properly align your eyes, they cannot prevent conditions like lazy eye from developing.

They cannot make the brain regard the image sent from the affected eye.

This is where vision therapy shines.

It doesn’t just correct the alignment of both eyes, it trains your brain to use both eye at the same time. Through vision therapy, your brain will learn to take the images from both eyes and merge them into a single 3D image.

In addition to that, it strengthens the neuro-pathways that make sure the eyes are working together at every turn and possible distance. This means that your eyes will work together (and with your brain) every direction you look and over any distance.

Vision therapy involves a program of exercises or procedures that are specially customized for you. It could be done by a behavioural optometrist with the assistance of a vision therapist.

You will need to visit the clinic for a comprehensive vision examination which will be followed by thorough evaluation.

Next, the behavioural optometrist will create an exercise plan that is customized for you and the degree of your strabismus.

Vision therapy is the only natural way to restore the alignment of the eye, train the brain to work with them simultaneously, and regain depth perception.

It is pain-free and the exercises can be fun for both kids and adults.

How Can You Begin Vision Therapy for Strabismus?


You can visit our clinic at this address to begin your vision examination. Or if you have got a busy schedule, you can book an appointment with our specialist and have a date marked down.

You could also have an instant chat with one of our specialists if you have got questions.

Remember, take advantage of our FREE eye test and have your eyes examined by top professionals in the country. Call or book your free appointment now!

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