Redirecting gaze to improve the cosmetic appearance of strabismus.

Purpose: We studied a behavioral technique in which strabismics can reduce the detectability of their eye turn by appropriately redirecting their gaze. We tested the efficacy of this technique for various amounts of strabismus and different positions of gaze.

Methods: We took digital images of a model gazing in different lateral directions and digitally edited them to simulate fixation with one eye on different lateral locations whereas the other eye was misaligned from the first by +/-0, 6, 12, 18, 24, and 30 Delta. Then we asked 22 lay observers to examine each of the images and to report whether or not they perceived eye contact and normal gaze.

Results: The observers reported that our model appeared to look normal and gave them eye contact two-thirds of the time for up to 18 Delta of exotropia and 12 of esotropia when she looked half her prismatic deviation to the side opposite her eye turn.

Conclusion: By appropriately directing their gaze, both exotropes and esotropes can improve the cosmetic appearance of their strabismus and increase the perception that they are looking at the observer. This may be useful during job interviews and other social encounters where eye contact and a good impression are critical. A drawback is that large amounts of strabismus may require the gazer to look far to the side of the observer's head where it may be difficult to maintain gaze and the observer's facial expression may be hard to read. However, all patients may be counseled on which eye to look at when engaging in conversation, as looking at the appropriate rather than the inappropriate eye can reduce the perceived amount of their strabismus. Also, when their portrait is being taken, the full amount of eccentric gaze could easily be used.