Adult Strabismus

There are four types of adult strabismus:

• Hypertropia – One eye looks up
• Hypotropia – One eye looks down
• Exotropia – One or both eyes look out
• Esotropia – The eyes cross as they look inward

Those who have constant strabismus have at least one eye that doesn’t look straight ahead. Eye patches, drops, and glasses may reduce or stop minor misalignments. Surgery is often the best permanent fix for adults who have adult strabismus.

People with intermittent strabismus are less likely to need surgery because their eyes don’t turn constantly. Their eyes sometimes look parallel. They can often function well with vision therapy, glasses, or patches.

Adults may experience sudden, intermittent symptoms that develop into constant strabismus with age.

Causes

Stiffness or weakness in the six muscles that control the eyes causes strabismus. One muscle controls the right movement while another directs the eye to look left. The remaining four muscles control up, down, and angled movements. These muscles cause strabismus if they do not work together in tandem.

Adults with strabismus may have had it as kids, but their bodies corrected their eye muscles as they grew. Others received treatment like eye patches that fixed the issue in their youth.

The muscles may weaken or stiffen with age. Those that are older have a higher risk of developing the condition. This is regardless of if they had it as children.

People with strabismus may have other health problems that disrupt their eye muscles. You have an increased risk of developing adult strabismus if you have had orbital or ocular eye surgery.

This is only a concern if the surgeon damages muscles in the eye. You also have a higher chance of developing strabismus as an adult if you have been in an accident or had a head injury.

Diabetes, strokes, and hypertension can limit the ocular muscle circulation or harm the nerves that operate them. Brain stem tumors, eye tumors, and thyroid disease may also increase the likelihood of experiencing double vision due to eye misalignment.

Prevalence

Strabismus affects around 4 percent of adults and 4 percent of kids younger than age 6. Those that are 65 years of age and older with adult strabismus are up to 27% more likely to have a musculoskeletal injury or fracture. This may be because of limited depth perception, as well as double vision.

Practical Manifestations

Those with normal eyesight look at one thing simultaneously. This means sending one image at a time to the brain. Children with strabismus see two images. Their brains filter out the picture from the eye that isn’t looking straight.

Without correction or natural improvement, they may only process information from their aligned eye. This prevents them from seeing depth.

For adults with strabismus, they see two separate images. This causes double vision. Adults with strabismus have brains that are used to seeing through both eyes.

This makes them incapable of choosing to see only out of the aligned eye. Adults with this condition may complain of tired eyes or eye fatigue.

It may feel as if something is pulling when they move their eyes. It’s common to lose depth perception, see double, struggle to read, and experience blurred sight because of the misalignment. Many individuals need to adjust their heads to improve their vision. This may lead to neck and back problems.

How Correction Works

Outpatient surgical correction is often the best option for adults with strabismus. The condition is only likely to worsen as a result of the aging process.

Surgeons will adjust the muscles by loosening, tightening, or moving them to improve eye alignment. One procedure may provide satisfying results. Several surgeries are sometimes needed to address several muscles.

The ophthalmologist uses local anesthesia to numb the area around the eye. They may use general anesthesia, so you are not conscious during the procedure. People who are anxious about the surgery often prefer this option because it is less stressful.

The surgeon cuts into the eye tissue to reach the muscles. They will tighten, loosen, or move them to align the eyes. They may repeat this procedure on both eyes if needed. Patients can return to regular eye use in several days.

Doctors recommend avoiding swimming or heavy lifting to prevent strained muscles and infection. Some people experience temporary nausea from the anesthesia.

Many patients have limited discomfort and no pain at the surgery site. The eyes are often red, and the eyelids may swell as the muscles heal. Over-the-counter medications and ice compresses can limit these side effects.

After the procedure, you may perform eye exercises. This includes focusing on different points to loosen and strengthen your eye muscles. These tasks can reduce the likelihood of strabismus worsening and prevent symptoms like headaches due to eye strain.

Evaluation Process

Patients with strabismus are often diagnosed by holding one hand over an eye to see if double vision stops. If this simple step prevents seeing two images, the person likely has strabismus.

Eye doctors will test symptoms such as blurred vision and misalignment that’s visible when looking at the patient. The eye doctor will record a full medical history. This will include strokes, hypertension, and thyroid disease that may contribute to the issue.

Age is a contributing factor to strabismus. Older individuals are more likely to develop the condition. There is no age “too old” to undergo corrective eye surgery so long as it can improve their quality of life.

Adult Strabismus Facts

• Strabismus is a term that means misalignment of the two eyes. It affects about 4% of the U.S. population and can be found in both children and adults.
• Strabismus can affect the quality of life in several ways based on the age of the patient. In childhood, it may result in amblyopia, a loss of vision due to disuse of an eye. In older children or adults, it may cause double vision. Finally, in all age groups, it may lead to significant social disadvantages and challenges.
• Often strabismus in childhood can be improved by using glasses or by patching one eye. In some adults, the addition of prism to eyeglasses can eliminate double vision and make functioning in society and at work much more feasible. In some children and adults, surgical repositioning of the eye muscles is necessary to achieve the best cosmetic and functional realignment of the eyes.
• One of the most commonly held misconceptions in the lay public is that adults with strabismus must “live with it” or risk double vision after surgery. As eye care colleagues, you are in a unique position to reeducate these patients. Surgery for adult strabismus patients has been shown to increase patients’ ability to get hired and promoted, and increases life style satisfaction.
• All of the pediatric staff at Associated Eye Care, including pediatric optometrists, pediatric ophthalmologists and specially trained ophthalmic technicians and orthoptists, are skilled in the diagnosis and nonsurgical management of strabismus in children and adults. For those who need advanced care, the three M.D.’s on the pediatric team offer years of experience as eye muscle surgeons.

Providing Surgeons and Experience

At Associated Eye Care, our surgeons that provide care during strabismus procedures are Dr. Schloff and Dr. Lynch. Both Drs. Schloff and Dr. Lynch have an extensive amount of experience when it comes to helping patients with strabismus treatment.

If you’re interested in scheduling an adult strabismus evaluation in our Woodbury location, please call (651)275.3000 or request an appointment online.

We also offer well vision visits, glaucoma tests, and cataract care. There are seven convenient locations across Western Wisconsin and Eastern Minnesota.

Protect your family’s vision health by using our high-quality, timely care. Schedule your eye exam at Associated Eye Care in Woodbury, MN today!