Vision depth and precision depend on two eyes focusing on the same thing at the same time. When one eye isn't in partnership with the other, it's known as strabismus. (Learn more)
An eye doctor can diagnose strabismus as part of a routine eye exam. (Learn more) You won't need a special test or a specialist's help to determine if this condition is impacting your eyesight.
If you have strabismus, your doctor can use special eyeglasses, eye patches, or surgery to correct the issue. Treatment is important, as this condition won't go away on its own. (Learn more)
What Is Strabismus?
The American Academy of Ophthalmology reports that strabismus symptoms can look different throughout the day. Eyes can switch roles, so one may be aligned in the morning and turned in an unusual way during the afternoon. The turn of the eye can also shift, so it may point in differing directions.
You may notice that your eye wanders when you:
- Focus on objects in the distance. The eye may turn outward when you scan the horizon. You may also experience this when you're driving.
- Stand in the sunlight. You may squint just one eye when you're exposed to bright light.
- Are tired. A long reading session can fatigue your eyes, and movement may happen at that time.
- Look at something close to your face. Images may seem blurred unless you close one eye.
The Prevent Blindness organization says about 2 percent of children have strabismus, and often, it's present at birth. But children can also show symptoms of the condition when they really don't have it at all. Babies are born with wide noses and a bit of extra skin around the eyes. These two attributes can make a baby's eyes seem misaligned, but with growth and time, the eyes develop an evenness.
If the misalignment is true and persists, it's vital for parents to ask for help. We once believed that kids would outgrow the problem as they age, but doctors now know it will get worse without treatment. The American Optometric Association says children older than 4 months with crooked-seeming eyes should have an exam to rule out strabismus.
Children with untreated strabismus can grow into adults with a vision deficiency in one eye. The brain becomes confused at the two focal points it is shown, and it learns to ignore the images from one eye. This can be treated, but prevention is a better tactic. Prompt treatment in childhood ensures that the brain doesn't make this shift.
Adults can also develop strabismus even if they never had it as children. It can be caused by the following conditions:
- Traumatic brain injury
- Guillain-Barre syndrome
- Grave’s disease
- Shellfish poisoning
- Eye disease or injury
Your mirror can help you understand if you have strabismus. As you look straight ahead into the glass, you may see one eye shifting off in an unusual direction. You may also notice blurred or double vision since your eyes are focused on different things.
These are just observations, not diagnostic details. But they can prompt you to visit an eye doctor, and there, a test can help to confirm strabismus.
Your eye doctor will dilate your eyes with drops, which makes the back of your eye easier to examine. When your eyes are fully dilated, your doctor will shine a light into your eyes. The eyes should reflect that light in the same way, with rays pointing in the same direction. If not, a strabismus diagnosis is appropriate.
Strabismus is also associated with vision problems, including farsightedness. Your doctor will check your visual acuity during the exam to ensure that this isn't contributing to the pointing problem in your eyes.
This test isn't painful, and it doesn't take your doctor long to complete. Once you have a diagnosis, you can get started on therapies to help you see better.
How Strabismus Is Treated
There are a variety of different approaches your doctor can use to help you overcome strabismus. The option that's right for you depends on your age, your overall health, and your personal preferences. Your doctor can help you make the right choice.
Your doctor might suggest:
- Glasses. Strabismus can worsen with strain, and if you've skipped correction for a vision issue, that can make your eyes work harder. A proper prescription could be a big help.
- Prism lenses. These specialized lenses for glasses bend the light as it enters your eye. Your muscles won't work so hard to move your eye, and that could ease your symptoms.
- Patches. Placing a patch over one eye could help to soothe overtaxed muscles and reinforce connections within your brain.
- Injections. A shot of botulinum toxin type A can weaken muscles that are working too hard, says the Cleveland Clinic. That injection could bring symmetry to eye muscles.
- Exercises. Muscles can be trained to work in harmony. Your doctor might ask you to move your eyes in a coordinated manner several times per day.
These treatments should help your eyes to work together, but your doctor will need to monitor your progress to make sure they're helping. You might have frequent visits to the office to talk with your doctor, and at each visit, your doctor might dilate your eyes and check your progress. It's important to keep every appointment, so your doctor can monitor how well your eyes are responding.
If these steps don't work, surgery might. An eye surgeon can tighten up loose muscles that control the eye. That could help them pull in partnership with their companions, and your eye misalignment could fade.
The American Association for Pediatric Ophthalmology and Strabismus says there's no age limit for this surgery. Even people 90 and older can benefit from surgical treatment for this condition. In most cases, insurance will cover this surgery. It's not a cosmetic condition. It's an issue that will impact your ability to see, so this is considered a functional correction.
It might seem unusual to have surgery for something that seems simply bothersome. That might be especially true if you've lived with strabismus your whole life. But it's important to remember that this isn't just a cosmetic concern.
Your brain can make adjustments that cut off communication with one eye. You'll lose depth perception, and that can limit your ability to do all sorts of things safely. Driving, cooking, knitting, and more could all become impossible for you.
If you are living with strabismus, talk with your doctor about what therapies are right for you.
During the consultation, we will ask you about your eye health history and your medications, and perform some tests. You will then be examined by the surgeon who will discuss your treatment options. Your personal Patient Counselor will help you throughout the process.
Your Counselor can review payment options and schedule you for surgery and related appointments, such as pre- and post-operative exams. Prior to your procedure you will have a dilated eye exam, and you should discontinue wearing your contact lenses and begin taking eye drops as instructed.
Plan to be at the center for two to three hours the day of your procedure. ICL eye surgery is a fairly brief outpatient procedure. Your surgeon dilates your eyes, and gives you a local anesthetic to numb the area. A tiny incision is made, and the clear lens is slipped between your iris and your eye’s natural lens. The day of your procedure should be a day of rest.
Your Patient Counselor will give you detailed post-operative instructions and eye drop regimen for your recovery. After ICL surgery, you’ll need several follow-ups with your eye doctor. Visual recovery is rapid, and you can expect noticeable improvement within a day or two. Most patients are generally able to return to their normal activities within two or three days following their procedure.
Bilateral Strabismus Surgery
While most treatments for strabismus involve strengthening the muscles in the weaker eye so it focuses better, there are some instances in which someone with strabismus may need bilateral strabismus surgery.
This procedure adjusts the muscles that change the alignment of the eyes relative to each other, either loosening or tightening them. While you may undergo a procedure on just one eye, or unilaterally, many surgeons find better outcomes if both eyes are adjusted (bilaterally).
The surgery adjusts the eye muscles attached to the sclera, or the wall of the eye, which are covered by the conjunctiva, a thin layer of transparent tissue that protects the outermost parts of the eye. After using local anesthetic eye drops, the surgeon will create a small incision in the conjunctiva and adjust the scleral muscles either by:
- Detaching the muscle and moving it further back, so it is looser.
- Detaching the muscle, removing a portion, and then suturing it back in place, making a more tense muscle.
You will need a few weeks to recover from the procedure and achieve good vision. You may need to take antibiotics and steroids to stave off infection. You’ll also need to maintain consistent visits with your ophthalmologist to monitor healing, lower rates of activity to promote healing, and temporarily use an eye patch to protect the eye.
Immediate, common side effects after bilateral strabismus surgery include:
- Pain in and around the eyes.
- Reddish tint to the whites of the eyes.
- Itching or dry eye.
- Double vision.
- Blurry vision.
Typically, you should not drive for at least one week after the procedure, so make sure someone is available to help you get to and from any eye exams. Typically, you can perform simple relaxing activities like reading and watching TV about a day or two after the operation, and you can return to work or school after about a week.
You should avoid moderate or high-intensity activities like forceful exercise for between two and four weeks or until your ophthalmologist clears you to try them. Avoid makeup and contact lenses for about a month. If your child undergoes bilateral strabismus surgery, do not let them play with anything they can get in their eyes, like sand or paints.
There is no age limit for this procedure, so even an older adult who has long struggled with strabismus may benefit from this operation. If you are an adult, you may need more than one surgical treatment, along with eye exercises and training, to fully treat strabismus.
Since strabismus is a medical condition, your vision insurance will cover at least part of the procedure. Your optometrist or ophthalmologist can let you know if you or your child is a good candidate for this procedure.
While surgery is considered a last resort, bilateral strabismus surgery can benefit you by improving or restoring your depth perception, clear and single-focused vision, and much more.
What Is Strabismus? (April 2014). American Academy of Ophthalmology.
Strabismus. Prevent Blindness.
Strabismus (Crossed Eyes). American Optometric Association.
Strabismus. (March 2019). U.S. National Library of Medicine.
What's to Know About Squint, or Strabismus? (March 2017). Medical News Today.
Strabismus (Crossed Eyes): Management and Treatment. (January 2019). Cleveland Clinic.
Adult Strabismus. (November 2016). American Association for Pediatric Ophthalmology and Strabismus.
Strabismus Surgery. (March 2019). American Association for Pediatric Ophthalmology and Strabismus (AAPOS).
Surgery: Squint. (January 2020). National Health Service (NHS).
Adult Strabismus Treatment. (May 2020). American Academy of Ophthalmology (AAO).