What is strabismus and why does it occur in adults?

Strabismus (struh-BIS-mus) is a condition in which the eyes are not properly aligned with one another. You may have heard this referred to as cross-eyed, wall-eye or lazy eye. An adult patient may have had this condition since childhood (that was either never diagnosed or unsuccessfully treated), experienced an illness or injury later in life, or in some cases, unfortunately, there is no identifiable reason that caused misalignment of the eyes.

Do I have strabismus?

Adults with strabismus may experience any or all of the findings/symptoms below:

• eye(s) cross in, wander out, float up or down
• the eyes do not move together
• double vision
• use a head position to relieve double vision
• eye fatigue
• overlapped or blurred images
• reading difficulty
• loss of depth perception

If you have any of these findings/symptoms, you should be evaluated by a specialist in adult strabismus at the Colorado Center for Eye Alignment.

Which adults are at higher risk of having or developing strabismus?

• if you have a family history of strabismus
• if you had strabismus in childhood
• if you have thyroid disease (Grave’s Disease)
• if you have Myasthenia Gravis
• if you have a history of a brain tumor
• if you have had a stroke or aneurysm
• if you have had a head injury
• if you have had an injury to the bone surrounding the eye (orbital fracture)
• if you have a low vision or non-seeing eye

What is binocular vision or fusion?

Each of your two eyes sees the world independently and sends a unique image to the brain. If you have binocular vision, it means that your brain can take these two individual snap shots and merge them together into a single, three dimensional perception of the world. When the eyes are not aligned properly, depth perception may be limited or non-existent.

Who treats misaligned eyes in adults?

All of the physicians at the Colorado Center for Eye Alignment are highly qualified to treat all forms of eye misalignment in adults. You will see in the biographies for each of our doctors that they have all obtained a fellowship in Pediatric Ophthalmology and Strabismus. Not only do our physicians have training in general ophthalmology, they have also completed additional education and training in the fields of pediatric ophthalmology and adult strabismus. An ophthalmologist trained in strabismus is the most qualified specialist to diagnose and treat any eye misalignment in adults.

Why didn’t my primary care physician, ophthalmologist or optometrist tell me that help was available?

Unfortunately, many doctors outside of our very specialized field are not aware that treatment for eye misalignment in adults is available.  Additionally, many are under the impression that surgery can only be performed as a child or that surgery is not very successful in adulthood. These claims are simply not true. We are frequently meeting with primary care physicians, ophthalmologist and optometrists in hopes to give them more information regarding adult strabismus and treatment options.

Can anything be done for adults with strabismus or misaligned eyes?

Absolutely! As an adult with eye misalignment you may have been told by a physician or friend that nothing can be done to re-align the eyes. This is simply not true. Eye muscle surgery is safe, effective and highly successful and it is never too late to make a decision for surgical correction. In some cases, non-surgical treatment, such as prism glasses, is an effective alternative to surgery.

I have already had one (or more than one) eye muscle surgery when I was a child. Is additional surgery an option?

Although you may have had eye muscle surgery in childhood, adolescence or even adulthood, you could still have a successful surgical procedure at this time. There have been advancements in the field of strabismus surgery. Specifically, adjustable sutures can improve the chance for a successful outcome.

Is eye muscle surgery cosmetic? Will my insurance pay for surgery?

All forms of eye misalignment are typically seen by insurance companies as medical, especially when coupled with eye strain or double vision. Eye alignment surgery is performed in adults for a multitude of reasons. Examples include: relief of double vision and restoration of depth perception. Even eye muscle surgery for the improvement in the appearance of ocular misalignment should not be considered cosmetic as surgery is performed to reconstruct abnormal ocular alignment. As a service to our patients, we will always pre-certify any surgical procedures with your insurance company to ensure that the surgery is a covered benefit.

What happens during eye muscle surgery?

Eye muscle surgery is just as it sounds: surgery on the muscles of the eye. There are six muscles attached to each eye. It is a cut and sew procedure, lasers are not used for this type of surgery. Generally speaking, each muscle that is being worked on must either be weakened (moved back on the eyeball) or tightened (a section is removed). Typically, eye muscle surgery is performed under general anesthesia. Our policy at the Colorado Center for Eye Alignment is to only utilize fellowship trained anesthesiologists with which we have worked closely for years. Once the patient is asleep, an incision is made on the white part of the eye (there are no skin incisions) and the muscles are separated from the eye and reattached with dissolvable sutures. It is important to know that the eye ball is not removed in order to perform eye muscle surgery.

What are adjustable sutures?

An adjustable suture is a type of slip-knot that is used to hold a muscle in place; however, this special suture allows the surgeon to re-adjust the position of the eye after the surgery is completed and the patient has had the opportunity to wake-up from anesthesia. At that time, if the eyes are not completely straight, the suture can be manipulated to move the muscle either forward or back to help resolve any residual misalignment. Once the patient and the surgeon are pleased with the alignment of the eyes, the suture is tied down and cut and can no longer be used to change the position of the eye.

Is hospitalization required for this type of surgery?

Eye muscle surgery is performed as an out patient procedure although; the need for hospitalization could arise depending on each individual’s general health. In most cases, adult patients return home after several hours in the out patient recovery unit. We perform surgery at the following locations: Midtown Surgical Center, SkyRidge Surgical Center and Presbyterian St. Luke’s Hospital.

How successful is eye muscle surgery?

Most individuals have complete or significant improvement in eye alignment with one surgery. The national success rate for eye muscle surgery is 80%; however, at the Colorado Center for Eye Alignment, because of our commitment to research and evaluation of our prior surgical cases, we have found that our average success rate is above that of the national average. The ability to use adjustable sutures in adult patients has also contributed to this increased success. Immediately following surgery, some patients experience double vision. This is due to the brain trying to figure out the new alignment of the eyes. Typically, we see this phenomenon resolve over several days to weeks. Determination of the success of eye muscle surgery must wait until several months after the procedure as it takes time for the muscles to heal.

What are the risks of eye muscle surgery?

Like all surgical procedures, eye muscle surgery does carry some risk; however, the most common risks are residual misalignment of the eyes and double vision. Despite our best efforts, careful measurements and use of adjustable sutures, occasionally, eye muscle surgery is only partially successful or a change in the alignment occurs after several years following a successful surgery. Additional surgery can be performed for residual misalignment or prism for a small deviation can be incorporated into glasses. Although most double vision that develops after strabismus surgery is temporary, persistent double vision is possible. Fortunately, the more serious risks of anesthesia complications, infection, retinal detachment and decreased vision are extremely rare.

Is eye muscle surgery painful?

Discomfort following eye muscle surgery is typically not severe. More commonly, patients report experiencing a dull headache, soreness, swelling, a pulling sensation with movement of the eyes and/or a sensation of foreign material in the eye. Although over-the-counter pain medication is often adequate for pain relief, stronger medications are sometimes prescribed. Our surgeons recommend limited physical activity and water in the eye(s) for at least two weeks. Many of our adult patients return to work within several days to a week following eye muscle surgery. Redness in the operated eye(s) should be expected and can last several days to weeks.