What Qualifies You for Strabismus Surgery?

Who May Be a Candidate for Strabismus Surgery?

You or your child may qualify for strabismus surgery when one or more of the following apply.

Persistent Eye Misalignment

Surgery may be considered when the eyes remain noticeably misaligned despite wearing the correct glasses or receiving other appropriate treatment.

The misalignment does not always need to be constant. Intermittent strabismus may also require surgery if it becomes more frequent, is difficult to control, or interferes with vision.

Double Vision

Adults with strabismus often experience double vision because the brain receives two images that it cannot combine properly. Surgery may help restore more comfortable single vision or reduce the area in which double vision occurs.

Prism glasses may be tried first in certain cases. Surgery may be considered when prisms do not adequately control the symptoms or would need to be excessively strong.

Reduced Depth Perception or Binocular Vision

Properly aligned eyes work together to create binocular vision and depth perception. When strabismus interferes with this coordination, surgery may improve the eyes’ ability to work as a team.

The amount of improvement depends on factors such as the patient’s age, the cause of the strabismus, how long the eyes have been misaligned, and the vision in each eye.

An Abnormal Head Position

Some patients tilt or turn their head to reduce double vision or improve eye alignment. Over time, this compensatory position can cause neck discomfort, headaches, fatigue, or difficulty performing everyday activities.

Strabismus surgery may help reduce the need for an abnormal head position.

Eye Strain or Difficulty With Daily Activities

Misaligned eyes can cause eyestrain, headaches, reading difficulty, reduced concentration, or problems with driving and work. These functional symptoms may support a recommendation for surgery, particularly when other treatments have not helped.

Social or Emotional Effects

Strabismus surgery is not performed only to improve appearance. Eye alignment can affect eye contact, communication, confidence, social interaction, school, and employment.

The American Association for Pediatric Ophthalmology and Strabismus notes that adult eye-alignment surgery can improve symptoms and quality of life and may be considered at any age.

Strabismus That Is Not Fully Corrected With Glasses

Some forms of eye crossing are related to farsightedness and may improve when the patient wears prescription glasses. Surgery may be considered if the eyes continue to cross even while the correct glasses are being worn.

Surgery generally corrects the remaining misalignment; it does not necessarily eliminate the need for glasses. 

Stable Eye Alignment Measurements

In adults with newly developed strabismus, the ophthalmologist may monitor the condition before recommending surgery. This allows time to determine whether the deviation is stable and whether an underlying condition needs treatment first.

The required waiting period varies. Children may need earlier treatment when eye alignment could affect visual development.

What Qualifies a Child for Strabismus Surgery?

A child may be considered for surgery when eye misalignment:

• Remains present after the correct glasses are prescribed
• Is constant or occurs frequently
• May interfere with binocular visual development
• Causes an abnormal head position
• Is unlikely to improve sufficiently with nonsurgical treatment
• Returns after previous treatment or surgery

Children with strabismus must also be evaluated for amblyopia, commonly called lazy eye. Amblyopia occurs when the brain does not properly use visual information from one eye. Treatment may include glasses, patching, or special eye drops.

Strabismus surgery aligns the eyes but does not directly correct amblyopia. A child may therefore need amblyopia treatment before or after surgery. Early treatment is important because untreated amblyopia can cause lasting vision problems, according to the National Eye Institute.

Can Adults Qualify for Strabismus Surgery?

Yes. Adults are not too old for strabismus surgery, even if the condition has been present since childhood.

Adults may qualify when strabismus causes:

• Double vision
• Poor depth perception
• Eye fatigue
• Difficulty reading or driving
• An abnormal head position
• Problems with eye contact
• Social or professional concerns
• Dissatisfaction with eye alignment

Adults who previously had strabismus surgery may also qualify for another procedure if the misalignment has returned or changed.