Eyes Crossed

WHEN TO SEE YOUR DOCTOR

* You suddenly have double vision and one or both of your eyes turns in, out, up or down.

What Your Symptom Is Telling You

So, okay, Mom was wrong. Reading in the dark doesn't dim your vision. And staring at your nose didn't make your eyes get stuck in the crossed position.

Chances are, if one or both of your eyes quite noticeably turns in, out, up or down, you were born with misaligned eyes that were never corrected. No one knows for sure, but doctors suspect that eye misalignment (technically called strabismus) may be caused by an imbalance in the nerve signals to the muscles controlling the two eyes. This forces them to point off in different directions, "like two cameras aimed at different spots," says Newton Wesley, M.D., O.D., chairman of the National Eye Research Foundation in Chicago. The reason you don't see "simulcast" images, however, is that your childhood brain turned off the weaker camera, he says. Generally, your stronger eye compensated and became the dominant, vision-retaining one.

It's also possible for eyes that have been in perfect tandem throughout life to suddenly or gradually veer off. This could be from an injury, cataract, diabetes, a disease or stroke. Adult brains can't ignore the image from the turned eye, however, so you see double.

Misalignment may also cause words to blur and run together when you're reading. If you have a tendency to be cross-eyed, just trying to thread a needle can give you a walloping headache and major eyestrain. If only one eye wanders out, dimness of vision (amblyopia) may result.

These misalignment problems may bother you all the time, or just when you are ill or tired. By the way, if you notice that one eye turns in or out slightly after removing your glasses, it simply means your eyes are releasing control of the proper alignment they had with the lenses, according to Eleanor Faye, M.D., an ophthalmologic surgeon at the Manhattan Eye, Ear and Throat Hospital. This is no cause for concern.

Symptom Relief

You'll need to see your doctor for diagnosis and treatment. There are also a few things you can do under your doctor's supervision to get your eyes working as a team.

Patch it up. When children have crossed eyes, the doctor may have them wear a patch over the stronger eye for six weeks to six months. "They're bound to get a few stares, but it's a good way to help strengthen and improve vision in the weaker eye," says Douglas Fredrick, M.D., clinical instructor of ophthalmology at the University of California in San Francisco.

Try pencil push-ups. Special eye exercises called orthoptics help stimulate your brain to use both eyes together, which often eliminates double vision, according to Dr. Fredrick. They are most effective when practiced regularly under the guidance of a trained doctor, he says.

One exercise that can help your eyes focus and fuse on a single image involves holding a pencil at arm's length and bringing it gradually toward your nose. If you have a problem with crossed eyes, you'll see double at eight inches away, says Dr. Fredrick. Practice keeping both eyes focused on the pencil as you gradually bring it toward you. Eventually, your eyes will learn to fuse the two images into one at about two inches.

Wear special specs. Some prescription lenses either stimulate or inhibit the movement of certain eye muscles, says Dr. Wesley. Glasses with built-in prisms can help redirect the line of sight and may help correct two images into one.

Get yourself in stitches. To reposition the misaligned eye, your doctor may suggest an operation involving adjustable stitches, says Dr. Fredrick. A bow-knot suture is left trailing out of the eye muscle so the doctor can tug on the muscle and fine-tune the alignment while you are actually looking at objects.

Do the penlight test. The earlier you treat a misaligned eye, the more likely you'll save the sight in the weaker eye, says Dr. Fredrick. It's not always easy to tell if babies have crossed eyes, however. They all have wide, flat noses and an extra fold of skin at the inner eyelid, creating a crossed-eye appearance.

True crossed eyes will reveal an off-center reflection in one of the pupils when you hold a penlight in front of a baby's eyes. If this happens, make an appointment with an ophthalmologist.