Adult Strabismus (Adult Eye Misalignment)

Why do adults get strabismus?

Adults can have eye misalignment for two main reasons:

  • It was present since childhood and never fully corrected, or
  • It started suddenly in adulthood.

If the misalignment has been there since childhood, it may become more noticeable over time, but it usually doesn’t cause double vision.

However, if it appears suddenly in adulthood, it almost always causes double vision (diplopia). This is a warning sign that should be checked by a doctor. Doctors will try to find out what’s causing the misalignment which may involve blood tests or scans like magnetic resonance imaging (MRI). Some common causes of new strabismus in adults include:

In some cases, doctors may not find a clear cause. 

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Why do adults develop double vision (diplopia)?

Double vision, also called diplopia, means you see two images of a single object. A common cause in adults is eye misalignment, known as strabismus. This happens when the eyes are not pointing in the same direction. As a result, the brain receives two different images-one from each eye-which leads to double vision. 

If your double vision disappears when you close one eye, it’s often a sign that eye misalignment is the cause.

Can adults with strabismus or double vision be treated?

Yes. There are several treatments that can help improve strabismus and diplopia, including:

  • Prism glasses to reduce double vision
  • Eye exercises to improve coordination
  • Botulinum toxin injections to adjust eye position
  • Strabismus surgery to straighten the eyes

Many adults can have successful eye straightening with surgery, depending on the cause.  Some surgeons use adjustable suture surgery to fine-tune the eye position shortly after the operation.

Who treats adult strabismus?

An ophthalmologist trained in strabismus is the best-qualified professional for diagnosis and treatment. You may also work with other specialists to identify underlying causes.

To find a specialist:

  • Ask your eye doctor for a referral
  • Visit the AAPOS directory (American Association for Pediatric Ophthalmology and Strabismus)
FIND A SPECIALIST

Patient Stories

PHYSICIAN
“Pediatric Ophthalmology is the ‘heart’ of ophthalmology”
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Dr. Hawke H. Yoon, Attending Physician of Ophthalmology at Ann & Robert H. Lurie Children’s Hospital of Chicago
PRIVATE PRACTICE
“The earning potential was much higher than I was led to believe…”
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Dr. David Skanchy, Ophthalmologist, Pediatric Eye Specialists
ACADEMIC
“It’s Always Fun”
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Dr. Honey Herce, Pediatric Ophthalmologist at Baylor College of Medicine | Texas Children’s Hospital
ACADEMIC
“Wherever you go, you will feel valued, you will feel needed…”
Dr. Ajay Soni
Dr. Ajay Soni, Ophthalmologist, PennState Health
PRIVATE PRACTICE
“Every day is a pleasure”
Dr. Danielle Ledoux
Dr. Danielle Ledoux, Ophthalmologist, Specialized Pediatric Eye Care & Adult Strabismus

Frequently Asked Questions

Strabismus means the eyes are not lined up correctly. It is estimated that 4% of the U.S. population has strabismus.
There are different types of strabismus. Doctors usually describe the strabismus based on which way the eyes are pointing. Common types of strabismus are esotropia (inward turn), exotropia (outward turn), hypertropia (upward turn) and hypotropia (downward turn). Measurements of the strabismus help the eye doctor choose the best treatment.
No. Many adults have double vision from eye misalignment, which can affect daily life. Surgery can help:
  • Improve double vision
  • Improve depth perception and sometimes side vision
  • Reduce the need for prism glasses, which can be bulky or uncomfortable
Strabismus can also affect a person’s confidence, social life, and even job opportunities. Straightening the eyes can improve both vision and overall quality of life.
Eye muscle surgery is considered reconstructive, not cosmetic. In most cases, insurance will cover strabismus surgery in adults, however, it's important to check with your insurance company to see what your specific plan covers.

Like any surgery, strabismus surgery does have some risks. The most common ones are:

  • Eyes still not fully aligned
  • Persistent double vision

More serious problems are rare, but can include:

  • Reactions to anesthesia
  • Infection
  • Scarring
  • Droopy eyelid
  • Bleeding
  • Vision loss

Your overall health can affect your risk. If you’re in poor health, the surgery might be done with local anesthesia instead of general anesthesia.

Most people see a big improvement in eye alignment after just one surgery. In some cases, the results may change over time or the surgery may only be partly successful. If that happens, another surgery might be needed.

If double vision remains afterward, it can often be helped with prism glasses.

Most people feel only mild discomfort after the surgery. Common symptoms include:

  • Headache
  • A pulling feeling when moving the eyes
  • A gritty or scratchy feeling in the eye
  • Redness and mild eyelid swelling

Some people may feel a bit nauseous after surgery, but this usually goes away quickly. Eating bland foods can help at first, and most people are back to a normal diet by the next day.

These symptoms usually last just a few days. Over-the-counter pain medicine and ice packs can help with the discomfort. Sometimes stronger medicine is prescribed if needed.

Most people return to normal activities within a few days, but your doctor may ask you to avoid swimming or heavy exercise for a few weeks.

Eye muscle surgery is done with either general anesthesia or local anesthesia to prevent pain.

  • General anesthesia puts you fully to sleep. It's commonly used.
  • Local anesthesia numbs the eye area while you stay awake. It is often combined with sedation to help you stay calm and relaxed during the procedure. It may be preferred for some adults.

The type of anesthesia depends on your health and the kind of surgery being done. Your doctor will help decide what’s best for you.

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.

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.

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