Strabismus, commonly known as crossed eyes or squint, is a condition where the eyes do not align properly and point in different directions. This misalignment, which can be constant or intermittent, affects the ability to use both eyes together effectively. Strabismus is often identified in childhood, though it can also develop in adults due to neurological issues or trauma. When non-surgical treatments are insufficient, surgery to adjust the eye muscles becomes a consideration for correcting the deviation. Evaluating the procedure requires understanding its dual purpose, success rate, and recovery process.
Understanding Surgical Goals
Strabismus surgery is driven by two primary goals: functional improvement and cosmetic realignment. The main functional aim is to restore binocular vision—the brain’s ability to fuse the images from both eyes into a single, three-dimensional perception. For adults, a major functional benefit is the elimination or reduction of double vision (diplopia) and the cessation of an abnormal head posture used to compensate for the misalignment. Cosmetic realignment addresses the visible misalignment of the eyes, which can turn inward (esotropia), outward (exotropia), or vertically (hypertropia/hypotropia). Restoring parallel visual axes can significantly enhance a patient’s quality of life and social function, though a straight appearance does not always guarantee functional improvement.
Expected Post-Surgical Outcomes
Strabismus surgery involves modifying the length or position of the extraocular muscles to restore proper alignment. Initial success rates for achieving satisfactory eye alignment with a single procedure are generally high, with approximately 80% of patients achieving the desired outcome. For patients who experience double vision before surgery, the rate of resolving this diplopia in the primary gaze position is reported to be over 95%. Misalignment can recur over time, or the eye may over-correct and deviate in the opposite direction, necessitating a secondary surgery (reoperation). Reoperation rates are around 6.7% within one year, increasing to about 10% within five years, and this risk must be factored into the patient’s decision-making process.
Potential Risks and Recovery
While strabismus surgery is generally regarded as safe, it carries certain risks and involves a defined recovery period. Rare but serious surgical complications include infection, excessive bleeding, or adverse reactions to the anesthesia; extremely rare complications, such as scleral perforation or vision loss, are also possible. Common and temporary post-operative side effects include grittiness, noticeable eye redness, and general discomfort that typically subsides within the first week. A temporary period of double vision is also common as the brain adjusts, typically resolving in the days or weeks following the procedure. Most patients return to basic activities within a day or two and resume normal work within one week, though full recovery, allowing for activities like swimming and contact sports, takes four to eight weeks.
Non-Surgical Treatment Options
Before considering surgery, many patients explore non-surgical interventions, which can be effective depending on the type and severity of the misalignment.
Non-Surgical Options
- Corrective lenses are often the first step, particularly for accommodative esotropia where correcting the refractive error may resolve the eye turn entirely.
- Prism lenses bend light before it reaches the eye, helping the brain fuse the images and reduce or eliminate double vision without changing the eye’s physical position.
- For children with strabismus associated with amblyopia (lazy eye), occlusion therapy involves patching the stronger eye to encourage the weaker eye to work harder and improve visual acuity.
- Vision therapy, a structured program of eye exercises, is a non-invasive approach that aims to improve binocular coordination and eye-teaming skills.
- Injections of botulinum toxin (Botox) are used to temporarily weaken specific extraocular muscles, which can be effective for smaller deviations or as an adjunct to surgery.