Strabismus (“turned eye”, “misaligned eyes”, “squint”)

Strabismus is a condition in which the eyeballs are not aligned properly and point in different directions. Nearly four in every 100 adults have this condition.

Adult strabismus results in visual, physical, and psychosocial disabilities. Successful strabismus surgery can relieve double vision and visual confusion, restore or establish depth perception, expand the visual field, eliminate an abnormal head posture, and improve psychosocial function and employability. Adults with strabismus should consult their ophthalmologist about the relative risks and benefits of surgery.

strabismus img - 1 - Dr Juanita Pappalardo

What causes strabismus in adults?

Most adults with strabismus have had the condition since earlier age in their life. However, strabismus can also begin in adulthood due to medical problems, such as:

  • Eye muscle sagging with age
  • Eye muscle nerve damage
  • Thyroid disease (Graves’ disease)
  • Myasthenia gravis
  • Brain tumours
  • Head trauma
  • Stroke
  • After cataract or retinal surgery

How is strabismus in adults treated?

Strabismus in adults can be treated using several methods, including:

  • Eye patch (occlusion of one eye)
  • Glasses containing prisms
  • Eye muscle surgery
Cataracts img2 - 3 - Dr Juanita Pappalardo

Eye Patch: This is simple and often resolve the double images instantly while investigations are undertaken, or recovery is anticipated.

Prism eye glasses: Eye glasses with prisms can correct mild double vision associated with strabismus in adults. A prism is a clear, wedge-shaped lens that bends, or refracts, light rays. When worn by an adult with strabismus who has mild double vision, the prism eye glasses realign images together so that the eyes see only one image. The prisms can be worn on the outside of the eye glass frames or can be manufactured directly into the lens itself. Prism eye glasses usually cannot correct more severe cases of double vision where images are far apart or double vision caused by weak or tight muscles.

Eye muscle surgery: Eye muscle surgery is the most common treatment for strabismus. Typically, strabismus occurs when the muscles surrounding the eyes are either too stiff or too weak. Our doctors can surgically loosen, tighten or reposition selected eye muscles so that the eyes can be rebalanced to work together.

Surgery for strabismus

Strabismus surgery can:

  • Improve eye alignment
  • Reduce or eliminate double vision
  • Improve or restore the use of both eyes together (binocular visual function)
  • Reduce eye fatigue
  • Expand peripheral (side) vision
  • Improve social and professional opportunities

Strabismus surgery is usually performed as a day procedure, using general or local anaesthesia. Patients may experience some pain or discomfort after surgery, but it is usually not severe and can be treated with over-the-counter pain medication such as paracetamol. Stronger medications for pain are sometimes needed and will be prescribed by your ophthalmologist or anaesthetist. You can often return to your normal activities within one to two weeks following surgery.

New strabismus procedures for complex strabismus

Surgery using adjustable sutures or eye muscle transposition is required in some cases with nerve damage, or previous unsuccessful eye muscle surgeries.

Valley Eye Specialists incorporates the Queensland Paediatric Ophthalmology and Strabismus Surgeons (QPOSS), a group of expert ophthalmologists who are trained in treating strabismus in adults, including complex strabismus.

Pre and Post operative photograph – Both eyes

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