Causes of strabismus in children

• Idiopathic infantile esotropia (also called congenital esotropia)
• Duane syndrome
• Mobius syndrome
• Brown syndrome
• Congenital familial external ophthalmoplegia
• Congenital third nerve palsy
• Congenital fourth nerve palsy

• Pseudostrabismus (false appearance of eye crossing that occurs in infants and young children with a wide nasal bridge and/or large epicanthal folds)

• Accommodative esotropia
• Intermittent exotropia
• Sensory esotropia (eg, due to cataract or other vision-depriving lesion)
• Ocular or orbital tumors
• Orbital injury
• Orbital cellulitis
• Ophthalmoplegic migraine
• Thyroid-related eye disease (Graves' disease)
• Orbital myositis

CNS disorders

• Brain tumors
• Increased intracranial pressure (eg, obstructive hydrocephalus, cerebral edema)
• Severe traumatic brain injury
• Intracranial hemorrhage
• CNS infection (eg, meningitis, encephalitis, brain abscess)

• Botulism
• Myasthenia gravis
• Benign sixth nerve palsy
• Guillain-Barre syndrome
• Ocular myopathy
• Multiple sclerosis

Infections

• Infections involving the eye and/or CNS (see list of causes on left side of table)
• Gradenigo syndrome (otitis media associated with eye pain and ipsilateral sixth cranial nerve palsy)
• Measles
• Diphtheria
• Polio

Drugs and toxins

• Lead
• Heavy metals

Metabolic/endocrine

• Thyrotoxicosis and thyroid-related eye disease (Graves' disease)
• Diabetic ketoacidosis (in the setting of cerebral edema)
• Severe hypoglycemia