How does strabismus happen?

Strabismus in adults can happen because of disease that affects your eye muscles (such as thyroid eye disease and myasthenia), disease that affects the nerves to your eye muscles (such as high blood pressure and diabetes) or trauma (where a physical force is applied directly to your eye).

Strabismus can also be caused by trying to correct short- or long-sightedness, or by poor vision in one eye as a result of amblyopia (or 'lazy eye').

Strabismus may not cause any symptoms. For some people it can be serious.

What are the benefits of surgery?

The aim of surgery is to improve the alignment of your eyes and reduce or stop any double vision.

Are there any alternatives to surgery?

Glasses or contact lenses can sometimes be used to control strabismus by helping your eyes to focus.

Double vision can often be controlled by wearing glasses with special prism lenses.

Botox injections into an eye muscle can temporarily help to straighten an affected eye.

What will happen if I decide not to have the operation?

You should continue treatment with your orthoptist to help improve your vision. The appearance of your eyes will usually stay the same. Wearing glasses with prism lenses may help to control any double vision.

What does the operation involve?

The operation is usually performed under a general anaesthetic but various anaesthetic techniques are possible. The operation usually takes about 1 to 2 hours.

Your surgeon will make a small cut on the surface membrane of your eye (conjunctiva). They will separate one or more eye muscles from the surface of your eyeball.

Usually using small dissolvable stitches, your surgeon will reattach the muscles, making them tighter or looser than they were before. This will depend on the correction that needs to be made.

How can I prepare myself for the operation?

Helping your surgeon

If you have adjustable stitches, you can help your surgeon by relaxing, listening carefully and following the instructions they give you.

Lifestyle changes

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.

Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.

Speak to the healthcare team about any vaccinations you might need to reduce your risk of serious illness while you recover. When you come into hospital, practise hand washing and wear a face covering when asked.

What complications can happen?

The healthcare team will try to reduce the risk of complications.

Any numbers which relate to risk are from studies of people who have had this operation. Your doctor may be able to tell you if the risk of a complication is higher or lower for you. Some risks are higher if you are older, obese, you are a smoker or have other health problems. These health problems include diabetes, heart disease or lung disease.

Some complications can be serious.

General complications of any operation

• Bleeding during or after the operation. Rarely, some redness may be permanent.
• Infection, which may cause blurred vision or even loss of vision.
• Allergic reaction to the equipment, materials or medication.
• Chest infection. Your risk will be lower if you have stopped smoking and you are free of COVID-19 (coronavirus) symptoms for at least 7 weeks before the operation.

Specific complications of this operation

• Continued strabismus. The squint may be under- or over-corrected, or a different squint may develop.
• Worse strabismus.
• Double vision. Rarely, double vision can be permanent and you may need to wear special glasses or a contact lens that completely blocks vision from one eye.
• A slipped or lost eye muscle, muscle scarring or making a hole in the eye with a needle.
• Reduced blood supply to the front of the eye (anterior segment ischaemia). The risk is higher if you have had a similar operation previously.
• The problem coming back. You may need another procedure to fix it.

Consequences of this procedure

• Scarring of the conjunctiva.
• Pain.

How soon will I recover?

You should be able to go home after a few hours.

Do not swim or lift anything heavy until you have checked with your surgeon. Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

Most people make a good recovery.

Summary

Strabismus surgery should make your eyes point in the same direction and improve any double vision.

IMPORTANT INFORMATION

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