Adult Strabismus Surgery
Strabismus surgery improves the function and coordination of eye muscles. In adults, fine adjustments can be made after the surgery while the patient is awake.
Strabismus in Adults
In strabismus (squint), the eyes are not properly aligned and look in different directions. Strabismus is often considered a childhood condition, but it can also develop in adults or reoccur after childhood surgery. For many affected patients, this results in double vision, which can interfere with daily activities and make safe participation in traffic impossible. Additionally, there are often significant social limitations, which can be very distressing.
Treatment Options
The sudden onset of strabismus in adulthood can indicate a cranial nerve disorder and must be urgently investigated. If strabismus has been present for a long time or since childhood, the investigation is not urgent.
Since visual development is already complete at this stage, the treatment of strabismus in adults is always considered an elective procedure and does not need to be performed immediately.
Often, the correct glasses or progressive lenses can improve eye alignment.
Treatment options for strabismus include:
- Glasses
- Bifocal or progressive lenses
- Prism glasses
- Botox injections
- Strabismus surgery
Surgical Options
Weakening
One method to weaken muscle function is to recess the muscle. Another option for weakening is to make a small incision within the muscle.
Strengthening
Muscle function can be strengthened by folding or pleating the muscle. This makes the muscle tighter and allows it to exert greater force.
Transposition
By repositioning, the pulling direction of the muscle can be changed. This is necessary, for example, when an eye muscle has completely lost its function and needs to be replaced by another eye muscle.
Adjustable Sutures
The use of adjustable sutures allows for fine-tuning the result after the surgery. In adults, the adjustment can be performed painlessly while awake.
Left image: Recession of the medial rectus muscle with an adjustable suture.
Right image: Transposition of the superior rectus muscle to the side.
Dr. Hunter et al., Archives of Ophthalmology 130, No. 2 (February 1, 2012)
Limitations of Strabismus Surgery
The “dosage” of the surgeries – that is, the decision on how much the eye muscle is moved, repositioned, or shortened – is based on empirical values that cannot predict the individual result and healing process.
Early Correction
In some cases, the result of the eye position immediately after the surgery is not satisfactory and a correction is required. This affects less than 5% of patients.
Late Correction
In many patients, the angle of strabismus changes over the course of life. Up to 20% of operated patients (including children) require a second procedure later in life.
The likelihood of needing another strabismus surgery increases if…
- … you have had strabismus for many years.
- … the angle of strabismus is very large.
- … three-dimensional vision is reduced.
- … you have very poor vision or are blind in one or both eyes.
Complications and Risks
As with any surgical intervention, there are risks, such as bleeding and infections. However, since the surgery is performed only on the surface of the eyes, the risk of these complications is extremely low.
How Often Can Strabismus Be Operated On?
Each surgery on the eye muscles alters the original anatomy and creates scar tissue between the conjunctiva, eye muscle, and sclera (white of the eye). This makes planning subsequent surgeries more complex and their execution technically more challenging. However, in most cases, multiple surgeries can be successfully performed. If another surgery is not possible, the situation can often be improved with treatment using botulinum toxin (Botox).