As we discussed in an earlier post, strabismus is a medical term that describes misalignment of the eyes. It is known by several other names: "wandering eye", "squint", or, most commonly, "crossed eyes". While common in children, it also affects 4% of adults.
Adults with strabismus tend to fall into two groups:
Those who had strabismus as children, before reaching visual maturity. These adults may not have received the appropriate treatment or correction when they were young. Alternatively, they may have received correction as children, only for their strabismus to recur.
Those who developed strabismus as adults. In this group, strabismus is commonly caused by trauma or injury, stroke, brain tumors, cranial nerve palsies, thyroid disease, or eye surgery for other problems. In some patients, there is no identifiable cause. These patients may experience frequent or constant double vision.
What are the symptoms of adult strabismus?
Adults may experience eye fatigue, double vision (diplopia), overlapping or blurred images (visual confusion), pulling sensation around the eyes, reading difficulty, and/or loss of depth perception. This may impair everyday activities, such as driving.
What are the treatment options?
Prism eyeglasses. For adults with small strabismus, a prism can be added to glasses to correct double vision. A prism is a clear, wedge-shaped lens that bends light rays. It can be added to glasses or be made as part of the lens itself.
Eye muscle surgery. Eye muscle surgery is the most common treatment for strabismus. Muscles involved in eye movement can be strengthened, weakened, or repositioned to rebalance how the eyes work together. Surgery is the best option for large or complicated strabismus. Adjustable sutures are often used during surgery so that eye alignment may be fine-tuned post-operatively. Not all patients will need this adjustment. If needed, the adjustment can be done within hours following surgery, sometimes a day or more later. Botox, or botulinum toxin A, is occasionally used in adult strabismus. Often incisional eye muscle surgery will have a more predictable and more permanent result than Botox.
What are the procedures, risks, and typical results of eye muscle surgery?
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 surgery is temporary; however, persistent double vision is possible and may require further surgery or treatment with prisms. Fortunately, more serious risks are rare. These risks include anesthetic complications, infection, bleeding, retinal detachment, and decreased or lost vision. Health risks vary depending on your general health.
Strabismus surgery is an outpatient procedure. Most people should expect to return to nearly all normal activities within several days. More extensive or complex surgeries may require longer recuperation. Swimming and heavy physical activities should be limited for up to several weeks after surgery.
Discomfort after surgery is usually not severe. Headache, pulling sensation with eye movement, and foreign body sensation in the eyes are the most common complaints. These symptoms typically last only several days. Over-the-counter pain medication is often enough to reduce discomfort, although stronger medication is sometimes prescribed.
Most adults, up to 80%, can expect significant improvement in eye alignment with one surgery. Of course, adults with strabismus is a diverse group. For those with more complex strabismus, the goal may be to achieve single vision in a straight-ahead position and in the reading position to maximize function. Sometimes, surgery is only partially successful, or changes in ocular alignment may occur over time after initial success. Additional surgery is a possibility, as is correction of residual double vision with prism glasses
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