Strabismus – misalignment of the eyes – is a common condition which can cause intractable symptoms including focusing difficulty and double vision. A fair amount of eye strain and headaches can develop when the eyes are not working together. While strabismus is very common in childhood, it also occurs in adults. Many of the problems that develop in adults are residua of previous childhood problems, but there are also many acquired problems that can affect the alignment of the eyes.
Patients with adult strabismus will note a turning or misalignment of the eye but some may only notice double vision. Many patients with significant misalignment of the eyes will not notice any obvious difference in the position of the two eyes. The most common symptom associated with this is double vision that improves if either eye is covered. More subtle symptoms include eye strain, image shifting, and difficulty focusing or holding a position in the page.
The treatment of adult strabismus or ocular misalignment first involves making an accurate diagnosis. Sometimes additional testing is needed to do this including blood work, and/or and MRI scan of the eye sockets and orbit. Once the condition has been identified and characterized, many patients can be noted to improve spontaneously and others will require treatment.
Treatments include occasionally recommending eye exercise or orthoptic exercises. The second line of treatment involves prisms which are added to glasses and can actually re-align the images so that the eye strain in double vision disappears. Finally, there are several different options for performing surgery on patients with adult strabismus to realign the eyes and create a more comfortable visual experience with the eyes working together. To accomplish this, small incisions are made on the outside of the eye and the eye muscles are accessed and repositioned. Depending on which direction the eye is turned, we can realign or reestablish its position in relation to the other eye by shifting various eye muscles. At times, we may use an “adjustable suture” which will leave the procedure unfinished on a “pulley” for adjustment with the patient participating in decision making the next day to try and get the best possible result. This surgery can be accomplished with minimal discomfort and recovery from this procedure happens quickly. It is a safe and effective treatment but, of course, carries with it certain small risks including infection, bleeding, and rare complications that can be associated with loss of vision.
If you have symptoms of ocular misalignment or your eyes appear misaligned, consider being evaluated for this adult strabismus condition by one of our specialists.