Conservative (Non-Surgical) Treatment for Strabismus
Strabismus (“squint”) refers to a misalignment of the eyes in which the visual axes are not directed at the same object. Especially in childhood it’s important to detect and treat squinting early to prevent permanent amblyopia (lazy eye) in the eye that deviates more often. Fortunately, several conservative (i.e., non-surgical) treatments are available to improve ocular alignment and promote binocular vision.
TL;DR
Glasses often help:
With the right glasses, squinting can be markedly reduced—or even fully corrected—in many children, particularly when previously undetected farsightedness is the trigger (accommodative esotropia).
Treat amblyopia early:
If squinting causes one eye to “see less,” that visual weakness (amblyopia) needs treatment. Typically, the stronger eye is temporarily covered with a patch to train the weaker eye. Alternatively, atropine eye drops can be placed in the good eye to temporarily reduce its acuity so the weaker eye is used more and thus trained.
Exercises can support treatment:
Orthoptic exercises (vision training) help in certain cases—for example, with convergence insufficiency (difficulty turning the eyes inward for near tasks).
Be cautious with “miracle vision training”:
Beyond established therapies, commercial vision-training programs are often not scientifically supported. In most cases such training offers no proven additional benefit.
Surgery only if needed:
Eye surgery is recommended only once conservative options have been exhausted or if the angle of deviation remains so large that binocular vision isn’t possible. Strabismus surgery on the eye muscles is generally low-risk and can markedly improve alignment when glasses, patching, and the like aren’t enough.
Glasses and Optical Aids
In many young patients with strabismus, well-fitted glasses can significantly improve alignment. Esotropia (inward deviation) that appears after the first year of life is often caused by unrecognized hyperopia. In such cases, correcting the refractive error with the “right” lens power often helps remarkably: the glasses reduce the excessive accommodative effort, and the child can suddenly align both eyes straight ahead.
Glasses can be prescribed even in the first year of life if medically necessary. It’s important that the spectacles are child-appropriate and comfortable; even toddlers usually accept them quickly.
Prism glasses
In addition to standard corrective lenses, prism glasses can be used as an optical aid. These special lenses contain prisms that shift the image to avoid double vision and reduce the amount the eyes must deviate.
With small angles of strabismus or latent tendencies (heterophoria), treatment is often unnecessary. If symptoms occur—e.g., headaches or quick fatigue—prism glasses can relieve them. It’s essential that they are fitted correctly by an ophthalmologist or orthoptist.
Prisms reach their limits with larger angle deviations; in such cases glasses alone are not sufficient to fully correct the squint.
Children with suspected strabismus should be examined early by an eye specialist. The ophthalmologist or orthoptist will first assess the refractive power and prescribe glasses if needed. Correcting all refractive errors lays the groundwork for further treatment. Often, within the first weeks of wearing glasses, it becomes apparent whether—and how much—the deviation decreases. For many children, glasses as the first step suffice to greatly improve strabismus.
Occlusion Therapy: Eye Patching and Atropine for Amblyopia
When a child squints, one eye often takes the lead while the other is “switched off” (the brain suppresses the deviating input). This leads to amblyopia (reduced vision) in the less-used eye.
This visual weakness is purely functional—not anatomical; the eye itself is healthy but, due to lack of use, hasn’t learned to see sharply. To prevent or treat amblyopia, the weaker eye must be specifically trained. This is done with classic occlusion therapy, in which the better eye is covered at times.
Eye patches
Patching follows a schedule based on severity and age—most often several hours daily. In younger children the covering time is typically shorter; with deep amblyopia, longer.
Important: The patch goes on the stronger (better-seeing) eye so the weaker eye is forced to “work.” With this training the disadvantaged eye gradually gains acuity.
Patching is never continuous and is used only as long as necessary to avoid inducing new weakness in the good eye.
During patching times, children should ideally do visually demanding near activities (drawing, puzzles, games) to challenge the weak eye as much as possible.
Patching requires discipline
Parents should be prepared: daily patching takes discipline. Young children often protest at first or try to remove the patch. Patience, consistency, and encouragement are key. Parental adherence is critical to keep to the prescribed occlusion times.
Ophthalmologists and orthoptists support families with tips (e.g., playful reward systems) and adjust the plan to the current situation. Sometimes it’s possible to patch more intensively during school holidays than during term time, when the child needs the better eye for learning. Such factors are considered in planning.
Regular check-ups are important: if there’s significant improvement over months, patching duration can be reduced. Amblyopia therapy often extends over many months to years, as vision must be stabilized until the visual system matures.
Alternatives to skin patches
If needed, there are alternatives. Some children cannot tolerate adhesive patches due to sensitive skin. In such cases, an occlusion cup (a small fabric cap) can be worn over the spectacle lens to cover the eye. With this approach, extra care is needed to ensure complete occlusion so the child can’t peek around it.
Another option is special Bangerter foils applied to the lens of the better eye. These semi-transparent or opaque foils reduce acuity in the dominant eye, similar to a patch, thereby encouraging use of the weaker eye.
Such measures should always be undertaken under ophthalmic supervision to calibrate training appropriately.
Atropine eye drops
Atropine drops offer another amblyopia treatment. Instead of a patch, the good eye is deliberately blurred using a medication (atropine 0.5–1% eye drops).
One drop on the weekend (e.g., once on Saturday and once on Sunday) is often enough to weaken accommodation (focusing) in the dominant eye for several days. The child can then no longer focus well at near with the better eye and automatically uses the weaker eye more. Depending on the correction in the stronger eye, atropine may work better or less well.
Studies have shown that atropine penalization is, in many cases, just as effective as patching. Many families also report that drops are easier to integrate into daily life because the child can keep both eyes open and the visible “stigma” of a patch is avoided. In one clinical study, adherence with atropine was indeed much higher than with patching.
In Switzerland, patching is still used predominantly. Atropine tends to be used when patching reaches its limits—for example, when a child categorically refuses patching or feels very uncomfortable with it at school.
In such cases, atropine penalization can be the more family-friendly alternative with fewer daily conflicts.
Another advantage: For certain forms of strabismus—such as when latent strabismus (heterophoria) would decompensate under patching—atropine allows the child to keep both eyes open. Binocular vision is preserved while the weaker eye is still trained.
Naturally, atropine drops must be prescribed and monitored by an eye doctor. Side effects are rare but possible (e.g., light sensitivity due to a wide pupil), so the therapy is carefully tailored.
In individual cases, the severity of amblyopia, the child’s age, and practical considerations determine whether patching or atropine is preferable. It’s often possible to alternate or combine both to achieve the best effect.
Orthoptic Exercises and Vision Training: What Makes Sense?
Orthoptics is the science of vision therapy and a subspecialty of ophthalmology. In specialized vision clinics (orthoptic departments in eye clinics or practices), orthoptists are experts in strabismus, amblyopia, and eye-muscle disorders.
These professionals not only perform vision tests but also guide exercises and support therapy over the long term.
Many parents hear about “vision training,” a loosely defined term. It’s important to distinguish which exercises are truly helpful and which promises should be viewed skeptically.
Certain types of strabismus can indeed be positively influenced by orthoptic exercises. A classic example is convergence insufficiency, a tendency to strabismus in which the eyes struggle to turn inward adequately for reading or near work.
Convergence training
Affected individuals (often school-age children or young adults) complain of blurred near vision, double vision, or headaches while reading. Convergence training targets this: with specific exercises—e.g., “pencil push-ups” (bringing a pencil toward the nose) or computer-based drills—the ability to converge the eyes is trained.
Scientific studies (e.g., the CITT study) have shown that structured orthoptic therapy can markedly improve convergence insufficiency.
Ideally, this training is supervised by an orthoptist and paired with at-home exercises. Many patients achieve lasting relief and can read comfortably for longer periods.
Simple coordination exercises for the eyes (e.g., alternating fixation between near and far objects) are also used to promote fusion of the two retinal images.
On the other hand, not every form of strabismus can be “trained away.” Medically recognized treatments for strabismus are primarily glasses, occlusion/atropine, and targeted orthoptic exercises (as described above). Beyond that, most “training” programs are unnecessary and their benefits are disputed. Reputable eye practices follow current scientific evidence and offer only established methods. Statutory health insurers likewise cover proven treatments, not experimental training programs.
Learning to see is an integral part of child development. It’s estimated that over 50% of the human brain is continually involved in processing visual stimuli. Everything a child does with eyes open (playing, crafting, romping on the playground, looking at books) strongly challenges and fosters the visual system.
This natural learning process is, in most cases, entirely sufficient to maximally stimulate binocular vision. Extra exercise programs add little, as long as the child is active in normal life and the core medical treatments (glasses, occlusion, etc.) are followed.
Book an appointment
Do you have further questions about strabismus and possible treatments, or would you like to schedule a consultation? Our team at FIRST SIGHT, directly at Zurich Main Station, will be happy to assist you.
Further Information
Strabismus Surgery in Children: Everything About Pediatric Strabismus Operations
After the Strabismus Operation: Recovery Process, Complaints & Follow-up
