Crossed Eyes in Dogs: Causes, Breeds at Risk & When to Worry

If you've noticed your dog's eyes don't seem to point in the same direction — one drifting inward toward the nose or outward toward the ear — you're observing a condition called strabismus. While a crossed eyes dog might look endearing or quirky, this eye misalignment can range from a harmless inherited trait to a symptom of a deeper neurological or muscular problem.

Understanding what causes strabismus, which breeds are predisposed, and when you should seek veterinary care will help you protect your dog's vision and overall health. This guide breaks down everything you need to know.

What Causes Crossed Eyes in Dogs?

Strabismus occurs when the muscles controlling eye movement are imbalanced or when the nerves directing those muscles are damaged. The result is one or both eyes deviating from their normal forward-facing position. Veterinary ophthalmologists categorize the causes into two broad groups:

Congenital (Inherited) Strabismus

Some dogs are born with eye muscle imbalances or structural abnormalities that cause misalignment. This type of strabismus is typically present from puppyhood and remains stable throughout the dog's life. It's most commonly seen in brachycephalic (short-nosed) breeds whose shallow eye sockets and skull structure affect how the extraocular muscles attach and function.

Congenital strabismus is usually non-progressive, meaning it doesn't worsen over time. The dog's brain often adapts to the misalignment early in development, so the dog may not experience significant double vision or functional impairment.

Acquired Strabismus

When a previously straight-eyed dog suddenly develops crossed or deviated eyes, it signals an underlying problem that demands prompt veterinary attention. Acquired causes include:

• Vestibular disease — inflammation or dysfunction of the inner ear or brainstem affecting balance and eye positioning (common in older dogs)
• Cranial nerve damage — trauma, tumors, or inflammation affecting cranial nerves III (oculomotor), IV (trochlear), or VI (abducens) that control eye muscles
• Orbital trauma — a blow to the eye socket that damages muscles or surrounding tissue
• Orbital tumors or abscesses — masses behind the eye that physically push the globe out of alignment
• Myasthenia gravis — an autoimmune condition causing muscle weakness, including the extraocular muscles
• Hypothyroidism — in rare cases, thyroid dysfunction can affect nerve and muscle function around the eyes
• Diabetic neuropathy — nerve damage secondary to uncontrolled diabetes mellitus

According to the Merck Veterinary Manual, acquired strabismus often accompanies other neurological signs like head tilt, circling, nystagmus (involuntary eye flicking), or loss of balance — all of which elevate the urgency of a vet visit.

Breeds Most Prone to Crossed Eyes

While any dog can develop strabismus, certain breeds carry a well-documented genetic predisposition. The condition is most prevalent among brachycephalic breeds, where selective breeding for flat faces has altered the geometry of the orbit (eye socket).

Among mixed-breed dogs, strabismus can appear if one or both parent breeds carry the genetic predisposition. A Boston Terrier–Chihuahua cross, for example, may inherit the shallow orbital structure that leads to eye misalignment.

Types of Strabismus Explained

Not all crossed eyes look the same. Veterinary ophthalmologists classify strabismus based on the direction the affected eye deviates:

• Esotropia (esotropic strabismus) — the eye turns inward toward the nose. This is the most common form seen in dogs, especially brachycephalic breeds. It's what most people picture when they think of a "crossed eyes dog."
• Exotropia (exotropic strabismus) — the eye turns outward toward the ear. Sometimes called "wall-eyed," this is less common but seen in breeds like the Pekingese.
• Hypertropia — the eye deviates upward.
• Hypotropia — the eye deviates downward.

Strabismus can also be unilateral (one eye affected) or bilateral (both eyes affected). Bilateral cases are more common in congenital presentations, while unilateral acquired strabismus often points to a localized problem like a tumor or nerve injury on one side.

When Crossed Eyes Signal an Emergency

For dogs with lifelong, stable strabismus that was present from puppyhood and hasn't changed, the condition is usually cosmetic. However, even congenital cases benefit from a veterinary ophthalmology exam to confirm there's no functional vision impairment or secondary issue like exposure keratitis (corneal drying due to incomplete eyelid coverage).

Diagnosis: What to Expect at the Vet

When you bring a crossed eyes dog to the veterinarian, the diagnostic workup depends on whether the strabismus is congenital or acquired.

For Congenital Strabismus

A basic ophthalmic exam typically costs $80–$150 at a general practice and includes:

• Schirmer tear test — measures tear production to assess dry eye risk
• Fluorescein stain — checks for corneal ulcers or abrasions
• Pupillary light reflex (PLR) testing — evaluates nerve pathway integrity
• Menace response and dazzle reflex — assesses functional vision

If the exam confirms simple inherited strabismus with no vision deficit, no treatment is necessary.

For Acquired Strabismus

Sudden-onset strabismus triggers a more extensive workup, potentially including:

• Complete neurological exam — assessing cranial nerves, proprioception, and vestibular function ($150–$300)
• Blood panel and thyroid testing — ruling out hypothyroidism, diabetes, and systemic disease ($120–$250)
• Advanced imaging (MRI or CT) — identifying brain lesions, tumors, or inner ear disease ($1,500–$3,500 depending on facility)
• CSF tap (cerebrospinal fluid analysis) — if inflammatory or infectious CNS disease is suspected ($200–$400)
• Referral to a veterinary ophthalmologist — specialist consultation typically costs $200–$350 for the initial visit

The American Veterinary Medical Association recommends seeking a board-certified veterinary ophthalmologist (DACVO) for complex or unexplained cases of acquired strabismus.

Treatment Options for Crossed Eyes in Dogs

Treatment depends entirely on the underlying cause. There is no single "fix" for strabismus — the approach is tailored to whether the condition is cosmetic or symptomatic of disease.

Congenital Strabismus: Usually No Treatment Needed

In the vast majority of inherited cases, strabismus is a cosmetic trait that doesn't impair the dog's quality of life. Dogs' brains are remarkably adaptive — puppies born with misaligned eyes typically develop compensatory mechanisms and don't experience the double vision that humans with strabismus report.

In rare cases where congenital strabismus causes functional problems (such as inability to fully close the eyelid, leading to chronic corneal exposure), surgical correction of the eyelid or extraocular muscles may be considered. This specialized surgery, performed by a veterinary ophthalmologist, typically costs $1,500–$3,000 per eye.

Acquired Strabismus: Treat the Underlying Cause

Living With a Crossed Eyes Dog: Practical Care Tips

For the many dogs whose strabismus is a benign, lifelong trait, daily life requires only minor accommodations:

Vision Compensation

Dogs with congenital strabismus rely more heavily on their other senses — hearing, smell, and whisker (vibrissae) feedback — to navigate their environment. Their functional vision is often better than you'd expect because the brain suppresses the misaligned eye's input to avoid double vision (a process called neural adaptation).

Eye Protection

Brachycephalic dogs with strabismus often have prominent eyes (exophthalmos) that are more vulnerable to injury. Consider these precautions:

• Avoid sharp brush or branch contact during walks — keep your dog on cleared paths
• Use a harness instead of a collar to avoid pressure on the neck and eye area during pulling
• Consider protective eyewear (such as Rex Specs or Doggles brand goggles, $60–$90) if your dog rides with their head out of car windows or hikes through dense brush
• Keep facial hair trimmed around the eyes to prevent irritation and improve visibility

Monitoring for Changes

Even with a stable congenital condition, check your dog's eyes monthly. Photograph them in consistent lighting so you can compare over time. Any shift in the degree of deviation, new squinting, redness, or discharge warrants a vet visit.

Corneal Care

Some dogs with strabismus cannot fully close the affected eye during sleep, leading to exposure keratitis — chronic drying and irritation of the cornea. If your vet identifies this risk, they may recommend:

• Lubricating eye ointment (e.g., Puralube Vet Ointment, approximately $12–$18 per tube) applied before bedtime
• Artificial tear drops (GenTeal or similar, $8–$15) used 2–4 times daily
• In severe cases, a surgical procedure called tarsorrhaphy (partial eyelid closure) to protect the cornea — typically $800–$1,500

Always consult your veterinarian before applying any medication to your dog's eyes, including over-the-counter products.

The Strabismus Myth: "Crossed Eyes Will Fix Themselves"

A common misconception among puppy owners is that strabismus will resolve as the dog grows. In reality, congenital strabismus is a structural or neuromuscular trait that does not self-correct. What sometimes happens is that mild puppy strabismus becomes less visually obvious as the skull matures and the orbits deepen — but the underlying muscle imbalance persists.

Conversely, if a puppy's eyes appear aligned and then begin to deviate at 6–12 months of age, this is not normal "growing" — it may indicate a progressive condition like an orbital mass or neurological disorder, and you should seek veterinary evaluation promptly.

Another myth is that strabismus causes blindness. In most congenital cases, the affected eye retains vision, though depth perception (stereopsis) may be reduced. Dogs compensate for reduced binocular vision with head movements and their wide monocular field of view.

Frequently Asked Questions

Is a crossed eyes dog in pain?

Congenital strabismus is not painful. Dogs born with misaligned eyes don't experience discomfort from the condition itself. However, acquired strabismus caused by trauma, tumors, or infections can be painful — signs include squinting, pawing at the eye, reluctance to be touched around the face, and decreased appetite. Any sudden-onset strabismus should be evaluated for pain and underlying disease.

Can strabismus in dogs be corrected surgically?

Yes, extraocular muscle surgery (similar to human strabismus surgery) can reposition the eye. However, veterinary ophthalmologists rarely recommend this for congenital cases because the condition is cosmetic and the surgery carries risks including overcorrection, scarring, and the need for repeat procedures. Surgery is more commonly pursued when strabismus causes functional problems like chronic corneal exposure.

Is strabismus hereditary? Will my dog pass it to puppies?

Yes, congenital strabismus has a genetic component, particularly in brachycephalic breeds. Breeding a dog with strabismus is generally discouraged by responsible breeders because the trait can be passed to offspring. The AKC recommends health screening including ophthalmologic exams before breeding any dog.

My dog's eye suddenly turned inward overnight. What should I do?

Sudden-onset strabismus is a veterinary urgency. Contact your vet or an emergency clinic the same day. This presentation can indicate vestibular disease, a brain lesion, cranial nerve injury, or an orbital mass. Don't wait to see if it resolves on its own — early diagnosis of conditions like brain tumors or inner ear infections significantly affects treatment outcomes.

Can I buy glasses or a patch to fix my dog's crossed eyes?

Unlike human children with strabismus who sometimes wear corrective patches or prism lenses, dogs do not tolerate eye patches well, and prism lenses are not practical for canine use. The veterinary approach focuses on treating underlying disease (for acquired cases) or accepting the cosmetic trait (for congenital cases).

Does pet insurance cover strabismus treatment?

It depends on the cause and your policy. Congenital strabismus is typically classified as a pre-existing or cosmetic condition and is not covered. However, acquired strabismus resulting from illness or injury (such as an orbital tumor or vestibular disease) is usually covered under accident-and-illness plans, subject to your deductible and co-pay. Average annual premiums for comprehensive pet insurance range from $500–$900 depending on breed, age, and location.