The factors responsible for what we commonly consider as strabismus remain an enigma. The complexity of the functional interrelationship of the entire sensory, motor and perceptual processes involved in the development and expression of binocular single vision cannot be overstated or ignored. Malformation or malfunction of any of the many components involved (skeletal and orbital structure, neural, muscular or perceptual) can affect, in some manner, this intricate functional balance.
In some instances a strabismic condition is manifested as a symptomatic constituent of a congenital syndrome (e.g., acrocephosyndactyly, craniofacial dysostosis, Duane's syndrome, etc.). For syndromes such as these the 'predisposing' mechanical factor is generally understood, and in most cases, the genetic component can be understood within the framework of classical Mendelian inheritance. Also, there are environmental factors that can produce the symptomatic condition, such as mechanical injury to the orbits or to the muscular apparatus of the eye as well as neurological damage or paralysis, assuming differential liability of individuals" constitutions to the force or impact of the environmental factor. However, when strabismic symptoms are manifested as an isolated entity (i.e., in the absence of other anatomic and/or physiologic abnormalites with no history of physical trauma), the causative factor or factors and the mediation of predisposition are not understood.
The apparent enigmatic involvement of genetic factors in the manifestation of strabismus has been discussed by numerous authors. General consensus is