Adult Strabismus

Adult strabismus is eye misalignment in an adult patient. The eye misalignment can occur in any direction, including inward, upward, outward, or downward. Adult strabismus is usually treated by a pediatric ophthalmologist who has special training in all types of strabismus..

Causes of adult strabismus

There are two main causes of strabismus in adults.

Recurrent childhood strabismus. In this type, the patient had strabismus as a child. The condition was treated or corrected, but the strabismus has reappeared now that the patient is older.

Adult acquired strabismus. This can occur spontaneously, from a trauma or from a disease such as diabetes or high blood pressure. Brain tumors are not a common cause of adult strabismus.

Symptoms of adult strabismus

A patient with adult strabismus may have one or several of the following symptoms.  

• Double vision
• Eye strain
• Headache
• Blurred vision
• Abnormal head posture

Treatment of adult strabismus

The treatment for this condition depends on the cause, duration, symptoms and severity of the strabismus.

• Observation – For mild cases, observation may be the best option, especially if the patient is not bothered by the problem.
• Prism glasses – These special glasses are used to align double images in patients with small eye deviations.
• Surgery – An ophthalmologist can perform a surgery to align the eyes in patients with any size deviation.  Surgery is sometimes the best option while in other cases surgery may not be useful.
• Eye exercises – Some conditions causing eye misalignment can be effectively controlled with eye exercises.
• Eyeglasses – Eye glasses may help patients with nearsightedness, farsightedness, or astigmatism control their eye misalignment.
• Eye patching – Some patients find temporary or even permanent relief from symptoms of double vision and/or eye strain by wearing a patch on one eye or by placing a piece of opaque tape on one lens of their eyeglasses.

Outcomes

Most adult patients with strabismus can have significant improvement of their eyesight with treatment. Strabismus recurs often and repeat surgery and/or other treatments are often needed.

Strabismus Surgery FAQs

What happens in strabismus surgery?

The procedure involves adjusting the tension on one or more eye muscles to change the way that the muscles pull on the eye. The goal of surgery is to improve the alignment of the eyes. A small incision is made on the conjunctiva, a membrane covering the white portion of the eye.  The muscle is then identified and the tension adjusted. 

Is a laser used in surgery?  No, this is a common question, but a laser is not used.

What are the risks of strabismus surgery?

The risks fall into 3 main categories. 

1. Risk of needing additional treatment and/or surgery. Even if the eye alignment is good after surgery, patients often develop recurrent strabismus and need additional treatment. This can occur soon after surgery or even years later.
2. Double vision is an uncommon complication, but can occur.
3. Partial or total blindness is very rare but could occur due to a complication or an infection.

What are the potential benefits of the procedure? 

Improved alignment of the eyes can benefit a patient by improving eye function and/or by improving appearance.

What are the alternatives to the procedure? 

When surgery is recommended, it is only after all non-surgical treatments have been tried. For mild strabismus, eye exercises can be helpful. Some doctors inject botulinum (Botox) into the eye muscles one or more times for patients who have strabismus and this can improve eye alignment as well. This treatment takes longer and is not commonly used.

What are the potential consequences of not undergoing surgery? 

The eye misalignment and its symptoms will continue. In young children with constant eye misalignment, loss of binocular vision can occur. Children with intermittent eye misalignment are generally at much lower risk of losing binocular vision.

What is the usual post-operative course and expectations? 

The operated eye(s) will bleed slightly on the day of surgery. The operated eye(s) will be very red after surgery. The redness will last several weeks. The operated eye(s) will typically be uncomfortable, but the pain is usually mild. Patients are typically seen in the clinic 3-10 days after surgery and then again several months later. Improved eye alignment is expected very soon after surgery.