Misalignment of the Eyes? What's That?

Becky Buegel, RHIA, CDIP, CHP Medical Coding Leave a Comment

Misalignment of the Eyes? What's That?

What do hypertropia, crossed eyes, and strabismus have in common? They’re different names for the same condition – misalignment of the eyes. Using the nose as the “common landmark” as it were, the condition that causes an eye to deviate away from the nose, while the other remains focused is a form of strabismus diagnosed as exotropia. The condition that causes an eye to drift inward (toward the nose) is diagnosed as exotropia. It’s estimated that 4% of the population in the U.S. has strabismus. 

Strabismus can occur in newborns, but more often than not, they will outgrow it by three months of age. If they don’t outgrow it early on, uncorrected strabismus can lead to amblyopia; the brain will start to ignore signals sent by the weaker, misaligned eye, which in turn, leads to vision problems. Though uncommon, strabismus can be manifestations of other medical conditions such as retinopathy of prematurity, retinoblastoma, cerebral palsy, and even traumatic brain injury. 

It is important to diagnose and treat strabismus as early as possible to prevent vision issues up to and including vision loss. Treatment can be as simple as eye muscle exercises and the use of glasses, or even a patch that covers the stronger eye, thus stimulating the weaker eye. Surgery is also an option, as is the use of a drug that, when used over the course of a few months, allows the eye muscles to balance themselves, resulting in restored eye alignment. 

Adults can be affected by strabismus, too. While each case is different, adult strabismus, AKA “crossed eyes,” is, more often than not, caused by other health issues such as diabetes, Grave’s disease, Myasthenia gravis, stroke, brain tumors, and, quite surprisingly, TMJ. 

There are several different types of strabismus. These include (but are not limited to): 

Infantile esotropia – manifested by significant inward turning of both eyes often starting on an irregular basis, but soon is constant. Usual onset is prior to six months of age; glasses do not correct the condition and surgery on the muscles of one or both eyes is performed to correct alignment. 

Accommodative esotropia – usually accompanied by a genetic predisposition and uncorrected farsightedness. The extra focusing effort required to keep distant objects in clear focus can cause the eyes to turn inward. Symptoms include double vision, closing or covering one eye when looking at a near object, and tilting/turning the head. Usually beginning early in life, treatment usually consists of glasses, though eye patching and or surgery on one/both eyes could be required. 

Intermittent exotropia – one eye fixates on a target while the other eye points outward. Symptoms include double vision, headaches, eye strain, difficulty reading and closing one eye when focusing on distance vision. Intermittent exotropia can occur at any age; treatment options include glasses, patching, eye exercises and/or eye muscle surgery. 

Strabismus must be diagnosed by an optometrist or ophthalmologist. Treatment will depend on the specific diagnosis and should be undertaken as soon as possible in order to prevent further damage to the eye(s).

source: https://www.pinterest.com/pin/668010557219896828/




Brown’s sheath syndrome 

A rare eye disorder characterized by defects in eye movements. 

Cyclic strabismus 

Cyclic strabismus is a rare condition that usually occurs in children and is characterized by alternating intervals of straight and strabismic eyes. In adults with the condition, strabismus surgery often eliminates the cycles. 


A form of heterophoria in which the vertical axis of the eye rotates to the right or left due to weakness of the oblique muscles 


A condition in which the eye rolls outward or inward around its front-to-back axis : rotational strabismus 

Duane’s syndrome 

A congenital eye movement disorder characterized by horizontal eye movement limitation: a limited ability to move the eye inward toward the nose (adduction), outward toward the ear (abduction), or in both directions. 


Inward turning of the eye 


Outward turning of the eye 


The directions the eyes are pointing at rest position are not the same as each other, in other words, they’re "not straight". 


Upward turning of the eye 


Downward turning of the eye 

Intermittent strabismus 

A type of strabismus that causes the eye to turn inward. 

Kearns-Sayre syndrome 

A rare neuromuscular condition that affects the eyes and other parts of the body, including the heart. It is coded to “Other paralytic strabismus” in ICD-10-CM. 

Mechanical strabismus 

Type of strabismus related to exophthalmos and Graves’ (thyroid) disease  

Paralytic strabismus 

An incomitant strabismus resulting from partial (paresis) or complete (paralysis) motor deficiency of one or a group of extraocular muscles supplied by the third, fourth or sixth cranial nerve. 


Also known as strabismus; the eyes point in different directions. It's particularly common in young children, but can occur at any age. 

Vertical strabismus 

A vertical misalignment of the visual axis or vertical deviation. 

 * List is not all-inclusive. 


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