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Pediatric Strabismus

What Is Restrictive or Paralytic Strabismus?

Strabismus encompasses a range of eye conditions in which the eyes are misaligned and/or do not move together. Problems with eye alignment can mean that there are problems with the:

  • Extra-ocular muscles that control eye movement
  • Cranial nerves 3, 4, and/or 6 that control the eye muscles and their movement

What Causes Restrictive or Paralytic Strabismus?

Restrictive or paralytic types of strabismus describe problems with eye alignment and movement that result from underlying conditions including:

  • Orbital fractures: Fractures in the bony eye socket that prevent proper eye muscle or nerve function
  • Congenital (present at birth) development problems
  • Disorders of the central nervous system that cause palsy (weakness) in cranial nerves 3, 4, and/or 6
  • Scars or inflammation of eye muscles
  • Thyroid disease

Symptoms of Restrictive or Paralytic Strabismus

Symptoms of restrictive or paralytic strabismus are similar to those of other types of strabismus. They may occur suddenly if they result from an injury, inflammation or neurologic condition. Or they may appear to worsen or not improve if they have been present since birth.

The most noticeable symptoms are:

  • Either eye would look inward, outward, upward, or downward
  • Head tilt or turn to compensate for the eye misalignment
  • Reduced eye movement
  • Double vision or loss of depth perception
  • Drooping eyelids (ptosis)

How Is Restrictive or Paralytic Strabismus Diagnosed?

You or your child’s pediatrician may notice that your child’s eyes are not aligned or do not move together. Restrictive or paralytic strabismus may be detected through well-baby eye exams or after neurologic or eye disease or trauma to the eye.

At Children’s National, we may recommend further testing to determine what is causing the restrictive or paralytic strabismus, as follows:

  • CT scan of the head and orbit to assess for fractures or eye muscle changes due to thyroid disease
  • MRI scans of the head and orbits to determine whether the eye misalignment is caused by nerve or muscle problems or by inflammation.

Treatments for Restrictive or Paralytic Strabismus

Treatment for restrictive or paralytic strabismus aims to align the eyes, eliminate double vision and regain depth perception. At Children’s National, our treatment options include:

  • Surgery on the eye muscles to realign the eyes
  • Surgery on the eye socket to repair fractures
  • Steroids for inflammation
  • Treatment of underlying diabetes or thyroid disease

Learn more about our Ophthalmology program at Children’s National.

Children's Team

Children's Team


Marlet Bazemore

Marlet Bazemore

Director, Pediatric Ophthalmology Fellowship Program
No Photo

Bethany Karwoski

Residency Program Coordinator for Pediatric Ophthalmology
William Madigan

William Madigan

Division Chief, Ophthalmology
Chairman, Pediatric Ophthalmology Fellowship Program



Our specialized pediatric ophthalmologists are experts at recognizing and treating complex eye conditions in infants and children.

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