Adult Strabismus (Eye Misalignment)

Adult Strabismus

(Adult Eye Misalignment)

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Can anything be done for adults with strabismus (misaligned eyes)?

Yes. Adults can benefit from some of the same treatment options that are available to children for treating strabismus. Treatment options may include prismatic glasses, specialized exercises to regain the coordination of both eyes (fusional exercises) and surgery. Most adults with misaligned eyes are able to have successful realignment with surgery [See figure 1]. It is important consult with an eye surgeon who specializes in strabismus surgery.

Why do adults get strabismus?

Adults may have misalignment either from a residual childhood strabismus or they may have new onset in adulthood. If the condition has been present since childhood, the misalignment may be suddenly noticeable, but there is usually no double vision.  In cases of misalignment suddenly occurring in adulthood, patients will almost always complain of double vision.  It is always important to evaluate the cause of the misalignment which may require blood tests or imaging studies like magnetic resonance imaging (MRI). New strabismus that develops in an adult can result from many diverse conditions including thyroid eye disease, stroke or tumors.  Sometimes, aging can cause a change in the soft tissue surrounding the eye that results in strabismus in the elderly, or there is no identifiable cause.

Is eye straightening as an adult strictly cosmetic?

No. Eye alignment surgery is performed in adults for several reasons. Adults frequently have disabling double vision because of eye misalignment. Surgery can often improve the double vision, depth perception and sometimes the field of peripheral vision.  If the prism correction needed to realign the eyes is large, the resulting glasses can be heavy, uncomfortable and can cause distorted vision.  Surgery can be considered to decrease the dependence on prism glasses. 
Also, strabismus affects adults in emotional, social, and economical ways. Realigning the eyes can “reconstruct” the abnormal appearance of the eyes providing a better quality of life.

Does my insurance cover the expense of this surgery?

Eye muscle surgery is reconstructive (not cosmetic). In most cases, insurance will cover strabismus surgery in adults, however, one should check with their medical insurance carrier to determine coverage with their specific plan.

Fig. 1: Adult Strabismus, or misaligned eyes, can be surgically corrected.

Is eye muscle surgery risky for adults?

Every surgical procedure has some risks. For strabismus surgery, the most common risks are residual misalignment of the eyes and double vision. Most double vision that occurs after strabismus surgery is temporary; however, persistent double vision is possible. Fortunately, the more serious risks are rare. These risks include anesthetic complications, scarring on the white of the eye, infection, droopiness of the eyelids, bleeding, retinal detachment, and decreased vision. Health risks vary with the general health of the individual. For those in poor health, surgery under local anesthesia instead of general anesthesia may be considered.

How successful is eye muscle surgery?

Most individuals have significant improvement in eye alignment with one surgery. Occasionally the surgery is only partially successful, or changes in ocular alignment may occur over time after initially successful surgery. Additional surgery may be indicated. Correction of residual double vision may be improved with the use of prism glasses.

How painful is this type of surgery?

Discomfort after eye muscle surgery is usually not severe. A feeling of nausea can occur due to some of the medications used for anesthesia or from the surgery itself.  Resuming eating with bland foods can help in the recovery.  Most people are back on a normal diet the day following surgery.  Headache, pulling sensation with eye movement and foreign body sensation in the eye are the most common complaints. The eyes are often red following surgery as the muscle heals.  There may be mild swelling of the eyelids. These symptoms typically last only several days. Over-the-counter pain medication often reduces the discomfort, although stronger medication is sometimes prescribed. Ice compresses can also be helpful.  Most patients return to full activity in several days. Some surgeons limit swimming and heavy physical activity for a few weeks after surgery. 

Is hospitalization required for eye alignment surgery?

Eye alignment surgery is usually performed as an outpatient procedure although the need for hospitalization varies depending upon general health and surgeon preference. This means that most people are released home a few hours following their surgery.  A trusted adult is needed to transport the patient home.  Most individuals return to nearly all normal activities within several days.

What age is considered "too old" to have eye muscle surgery?

Eyes can be straightened at any age and should be considered as a treatment option if it is likely to improve symptoms and enhance quality of life. In most cases, eye muscle surgery is a successful, safe, and effective treatment for strabismus in adults of all ages. The good news is that it is never too late for surgery. Even patients in their 90's have benefited from surgical correction.

I am embarrassed by my misaligned eyes and avoid looking people in the eye. It seems to me that people are distracted by my wandering eye, causing problems with social interaction and difficulty getting the job I want. Can this really be true?

Yes. Recent studies confirm these observations. Misaligned eyes can hinder social interaction, self-confidence and employment opportunities. All individuals deserve straight eyes if possible.

Who treats misaligned eyes in adults?

An ophthalmologist trained in strabismus is the most qualified specialist to treat adults with misaligned eyes. In determining the cause of the misalignment, other specialists may be utilized.  Adult strabismus specialists can be located in the directory of AAPOS, an organization of eye surgeons with special training in eye muscle problems. Your own eye doctor may also have a recommendation.

Many adults with strabismus wonder, "Why do I go to a pediatric eye specialist? I'm not a child anymore." The answer is that misaligned eyes are common in children and ophthalmologists who care for children tend to have the most expertise in treating eye muscle conditions.

Updated 12/2022




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