Observing a newborn’s eyes can often be a source of parental concern, particularly when one eye seems to drift inward or outward independently of the other. Eye alignment in infants is a process that develops gradually, and this occasional wandering is a normal part of visual development. The eyes are learning to focus and coordinate their movements, which is a complex task for a brand-new visual system. For the first few months of life, a temporary lack of perfect alignment is common and does not usually indicate a long-term vision problem.
Understanding Temporary Eye Misalignment
The appearance of crossed eyes in a baby often stems from one of two common, non-threatening causes. The first is the immaturity of the six extraocular muscles surrounding each eye, which are responsible for all eye movements. These muscles are not yet fully coordinated, leading to intermittent episodes where the eyes fail to work together. This lack of coordination means the eyes may occasionally drift or cross sporadically as the infant learns control.
The second common cause is an optical illusion known as pseudostrabismus, or false strabismus. This illusion is created by the infant’s characteristic facial features, such as a wide nasal bridge or prominent epicanthal folds. These folds of skin near the inner corner of the eyes can partially cover the white part of the eye, making it look as though the eye is turning inward toward the nose.
With pseudostrabismus, the eyes are actually aligned correctly, and the appearance of crossing is purely cosmetic. As the child grows, the face matures, the nasal bridge narrows, and the skin folds recede, naturally resolving the illusion. Pseudostrabismus requires no treatment because it does not affect the child’s visual development.
The Developmental Timeline for Eye Coordination
The process of achieving stable eye coordination follows a predictable schedule in a baby’s first months. In the first four weeks of life, a newborn’s eyes may wander frequently, and it is normal for them to cross or drift out of alignment often. The infant’s focus is best on objects only eight to ten inches away, roughly the distance to a parent’s face during feeding.
Between one and three months of age, coordination begins to improve noticeably as the developing brain sends stronger signals to the eye muscles. The eyes start to work together more effectively, allowing the infant to follow a moving object with both eyes, tracking it across their field of vision. By two months, uncoordinated movement should become less frequent.
The period between four and six months marks a significant milestone in visual development. By this time, the infant’s eyes should be reliably working together, and any previous intermittent crossing or wandering should have stabilized. The eyes can now focus on objects both near and far. This improved binocular vision allows for the initial development of depth perception, the ability to judge distances.
Identifying True Strabismus and When to Seek Help
While temporary misalignment is normal, true strabismus is a persistent condition where one or both eyes are genuinely misaligned, turning inward, outward, upward, or downward. Unlike the temporary wandering of a newborn, true strabismus is a constant deviation that prevents the eyes from focusing on the same point simultaneously.
If the crossing persists beyond the four- to six-month developmental window, a professional evaluation is necessary. Other warning signs include a sudden onset of eye crossing at any age, frequent squinting, or the baby consistently tilting their head to look at objects. These behaviors may indicate the baby is trying to compensate for double vision caused by the misalignment.
Untreated strabismus carries a serious risk of developing amblyopia, commonly known as lazy eye. Amblyopia occurs because the brain begins to ignore the visual input from the misaligned eye to avoid seeing double. This can lead to permanent vision loss in that eye if not corrected early. Early intervention is important to ensure proper vision development.
If a parent suspects true strabismus, consult with a pediatrician or a pediatric ophthalmologist, an eye doctor specializing in children’s vision. Treatment approaches vary depending on the cause and severity. Treatment may include patching the stronger, dominant eye to force the brain to use the misaligned eye. Corrective lenses may also be prescribed, and in some cases, surgery on the eye muscles may be necessary to restore proper alignment.