Adult Strabismus (Eye Misalignment)

“I’m an adult. Why should I see a pediatric ophthalmologist?”
For most of your eye care needs as an adult, you really are best served by your general ophthalmologist. However, issues of double vision and eye misalignment are ones that your general ophthalmologist does not deal with nearly as frequently as he does other problems, whereas a pediatric ophthalmologist deals with these issues all day every day. Thus a pediatric ophthalmologist is prepared to evaluate and treat your double vision or eye misalignment in a more efficient way, including an appropriate recommendation regarding whether further medical work-up or a scan of the brain may be needed. A pediatric ophthalmologist is also comfortable and proficient in using non-surgical treatment such as prisms to control double vision whenever possible, instead of surgery. If surgery is necessary, the pediatric ophthalmologist is best equipped to do this, as this is what he does all the time (whereas, if you need a cataract removed your general ophthalmologist is your best choice).

“How does eye misalignment in adults differ from eye misalignment in children?”
Many adults with eye misalignment have had eye misalignment since childhood and either never got it fixed or their eyes drifted again after having them straightened in childhood. In these cases there is seldom an underlying medical cause for the misalignment. However, adults with new onset eye misalignment require prompt further evaluation. Causes of eye misalignment in these situations include trauma, diabetes, thyroid disease, neurologic conditions including myasthenia gravis, and even brain tumors. A pediatric ophthalmologist can tell you which labs, scans or other studies you need and which ones you don't in order to reach a diagnosis as quickly and as cost effective as possible.

Whereas children with eye misalignment very seldom have double vision, adults who acquire eye misalignment usually do have double vision even if the misalignment is small enough that it might not be noticeable cosmetically. This is extremely bothersome, and patients frequently find themselves closing or covering one eye to get rid of the double vision. The pediatric ophthalmologist can manage this double vision by using prisms or, if necessary, eye muscle surgery to realign the eyes.

Effects on Interaction with Others
Many adults are understandably self-conscious about their eye misalignment. They note that it affects their confidence in speaking with others in their work or in social situations: they frequently comment that the person they are talking to doesn’t know which eye to look at. Studies have shown that potential employers do in fact take eye misalignment into account when assessing an applicant’s qualifications for a job.

Glasses and/or surgery can be used to help treat eye misalignment in adults as well as children. However, additional options are available to adults. Some adults with double vision can be treated with prisms in their glasses, thus avoiding eye muscle surgery. If eye muscle surgery is needed, some adults may benefit from use of an “adjustable suture” in which the position of the suture is not set in the operating room but can be adjusted in the office later that day or the next day.

“I thought “lazy eye” couldn’t be fixed after age nine.”
Eyes can be straightened with eye muscle surgery at any age. Unfortunately, many adults are walking around with significant eye misalignment because they remember having been told that “lazy eye” can’t be fixed after age nine. The problem here is with the term “lazy eye.” Amblyopia (poor vision in one eye) is in fact very difficult to treat after age nine, but strabismus (eye misalignment) can be fixed at any age.

“I’ve heard I will get double vision if I have eye muscle surgery. Is this true?”
Almost certainly not. Patients are often told this by eye doctors who either do not do eye muscle surgery, or who do not do it very often. If you do not have double vision before eye muscle surgery, you almost certainly will not have double vision after your eyes have healed from eye muscle surgery. In some cases there may be a period of double vision (perhaps two or three weeks) while the brain adapts to its new alignment, but even this is the exception rather than the rule. Double vision that persists can, though, result if surgery produces an overcorrection (such as an outward drift after surgery for crossing). That is uncommon, but if it were to occur, and to persist, it could be managed with prism or, if necessary, another surgical procedure.


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