Strabismus in Adults: Treatment Options Beyond Childhood

You may think of strabismus—commonly called crossed eyes or eye turn—as a childhood condition. But the reality is that many adults either develop strabismus later in life or continue to live with a childhood diagnosis they never fully addressed. The good news is that effective treatment options exist for adults, and it's never too late to explore them.

What Is Strabismus?

Strabismus is a condition in which your eyes don't align properly. Instead of both eyes pointing at the same object, one eye may turn inward, outward, upward, or downward. This misalignment can be constant or come and go, and it can affect one eye or alternate between both eyes.

When your eyes aren't aligned, your brain receives two different images. In children, the brain often learns to ignore one image to avoid confusion—a process called suppression. In adults, strabismus typically causes double vision (diplopia), eye strain, and sometimes social or professional discomfort.

Why Does Strabismus Develop in Adults?

Adult strabismus can arise for several reasons:

Childhood strabismus that persists: Some people had strabismus as children but never received treatment or had incomplete treatment. The condition may worsen or become more noticeable over time.

New-onset strabismus: Adults can develop strabismus due to:
- Thyroid eye disease, which causes inflammation and changes in eye muscle function
- Stroke or neurological conditions affecting the nerves that control eye movement
- Diabetes or other systemic diseases that damage eye muscles or nerves
- Head trauma or injury
- Uncorrected refractive errors (nearsightedness, farsightedness, or astigmatism) that strain the focusing system
- Weak eye muscles from aging or certain medications
- Orbital tumors or other space-occupying lesions

Accommodative esotropia: This occurs when your eye's focusing system (accommodation) is too strong, causing the eyes to turn inward. It's often linked to uncorrected hyperopia (farsightedness).

How Strabismus Affects Adults

Unlike children, adults with strabismus typically experience:

• Double vision: Your brain cannot suppress images as easily as a child's brain can, so you see two images instead of one.
• Eye strain and fatigue: Your eye muscles work harder to try to align the eyes, leading to discomfort.
• Reduced depth perception: Proper eye alignment is essential for three-dimensional vision.
• Social or professional concerns: Some adults feel self-conscious about the appearance of misaligned eyes.

Treatment Options for Adult Strabismus

Corrective Lenses

If uncorrected refractive error is contributing to your strabismus, the first step is often a comprehensive eye exam and proper eyeglass or contact lens prescription. Sometimes, correcting hyperopia or astigmatism is enough to reduce or eliminate the eye turn.

Vision Therapy

Vision therapy (also called orthoptics or eye exercises) is a structured program of eye exercises and activities designed to improve how your eyes work together. A trained vision therapist guides you through exercises that strengthen eye muscles and improve coordination.

Vision therapy works best for:
- Convergence insufficiency (difficulty turning eyes inward to focus on near objects)
- Mild to moderate strabismus
- Patients motivated to commit to regular practice

Therapy typically involves office visits once or twice weekly, plus home exercises. Results vary; some patients see significant improvement, while others may need additional treatment.

Botulinum Toxin Injections

Botulinum toxin (Botox) can be injected into the overacting eye muscles to temporarily weaken them, allowing the eyes to realign. This approach:

• Works best for small to moderate eye turns
• Provides temporary results (effects last 3–4 months)
• May require repeated injections
• Can be combined with other treatments
• Avoids surgery but doesn't permanently correct the problem

Your eye care provider can determine if you're a candidate for this option.

Surgical Correction

Strabismus surgery involves adjusting the position or strength of the eye muscles that control eye movement. The surgeon may:

• Weaken an overacting muscle by moving its attachment point farther back on the eye
• Strengthen an underacting muscle by shortening it
• Adjust one or both eyes, depending on the type and severity of misalignment

Who benefits from surgery?
- Adults with moderate to large eye turns
- Those who haven't responded to glasses, vision therapy, or injections
- People with double vision that significantly affects daily life
- Patients seeking a permanent solution

What to expect:
- Surgery is typically outpatient and performed under general anesthesia
- Recovery takes 1–2 weeks; full healing takes several weeks
- Most patients see improved alignment immediately, though fine-tuning may take weeks
- A second surgery is sometimes needed if alignment isn't perfect after the first procedure
- Success rates are high (70–80% achieve good alignment with one surgery)

Prism Lenses

Prism lenses bend light to change where images appear on your retina, reducing the amount of eye turn needed to fuse the two images. Prisms can:

• Reduce or eliminate double vision
• Decrease eye strain
• Be incorporated into eyeglasses
• Serve as a temporary or permanent solution

Prisms work best for small eye turns and are often used while awaiting surgery or as a long-term management strategy.

Choosing the Right Treatment

The best treatment for your strabismus depends on:

• The cause: Addressing the underlying problem (thyroid disease, refractive error, neurological condition) is essential.
• The severity and type of misalignment: Small turns may respond to glasses or prisms; larger turns often require surgery.
• Your symptoms: Double vision, eye strain, and cosmetic concerns all factor into the decision.
• Your goals: Some people prioritize alignment for appearance; others focus on eliminating double vision or reducing strain.
• Your overall health: Age, other medical conditions, and ability to undergo surgery influence your options.

The Importance of a Comprehensive Evaluation

If you suspect you have strabismus or are experiencing new double vision, eye strain, or misalignment, schedule a comprehensive eye exam. Your eye care provider will:

• Measure the degree of eye turn using specialized tests
• Assess your eye muscle function and coordination
• Check for underlying causes (refractive error, thyroid disease, neurological issues)
• Evaluate your vision quality and depth perception
• Discuss your symptoms and treatment goals
• Recommend the most appropriate treatment plan for you

Moving Forward

Adult strabismus is treatable, and you have multiple options to explore. Whether you choose corrective lenses, vision therapy, injections, surgery, or a combination of approaches, the goal is to restore comfortable, aligned vision and improve your quality of life. Don't assume that because strabismus has been present for years, nothing can be done. Modern treatment approaches offer real solutions for adults of all ages.

Take the first step by scheduling an eye exam with an eye care professional who can evaluate your specific situation and help you understand your options.