Charles D. Fritch MD,
FACS, is a renowned
ophthalmologist, founder
of Fritch Eye Care Medical
Center, and Medical
Director of a fully equipped
Ambulatory Center.

Fritch Eye Care Medical Center
8501 Brimhall Road, Suite 401 & 402
Bakersfield, CA 93312
Tel: 661-665-2020


Strabismus in Adults

What is adult strabismus?

Strabismus is a condition in which the eyes are misaligned and point in different directions. Most strabismus in adults has been present since childhood.

Strabismus which occurs in adults without a history of childhood eye misalignment should be carefully evaluated for medical or neurological causes such as:

  • Diabetes;
  • Thyroid disease;
  • Myasthenia gravis; Brain tumors;
  • Strokes;
  • Other neurological disorders.

What are the symptoms of adult strabismus?

If the strabismus has been present since early childhood, the symptoms are usually minimal. If it develops later, the most common symptom is double vision. Some adults with strabismus will have:

  • Eye strain;
  • Discomfort when reading; Headaches;
  • Abnormal head positions to use their eyes together.

What causes double vision?

When your eyes are not aligned properly, each eye sees a different image. Infants and children can learn to suppress or ignore the image from one eye in order to avoid seeing a double image. Adults are unable to suppress one of the images, and therefore have double vision. This can be relieved by closing one eye, wearing a patch or aligning the eyes.

How is adult strabismus treated?

There is a common misconception that strabismus in adults is difficult or impossible to treat. Actually, adults with strabismus have many different treatment options including:

  • Eye exercises;
  • Glasses with prisms;
  • Botulinum injections;
  • Eye muscle surgery, with or without adjustable sutures.

Eye muscle exercises may be helpful in treating special problems such as convergence insufficiency, a condition in which the eyes are misaligned only for close work or reading.

Glasses with prisms are most useful for correcting small deviations. The images are realigned by prisms to compensate for the misalignment of the eyes, and the double vision may be relieved.

The eye muscle can be injected with Botulinum, a drug that temporarily paralyzes the muscle. Its effect lasts for a few months and may result in a permanent change in the eye alignment. This technique is useful in selected cases, especially in individuals with nerve palsies.

How does surgery work?

The most common treatment for strabismus at any age is surgery on the eye muscles. A tight muscle is surgically weakened by moving the muscle back on the eye. A weak muscle is tightened by removing a small segment of the muscle to shorten it. Surgery may involve the straight eye, the misaligned eye, or both.

What anesthetic is used in strabismus surgery?

Usually strabismus surgery is performed under general anesthesia. Sometimes surgery can be performed while the individual is awake or slightly sedated. In this situation, an injectable local anesthetic or anesthetic eyedrops are used.

What are adjustable sutures?

Adjustable sutures are a surgical technique that allows for some "fine tuning" of the alignment after surgery. The operation is performed in two stages.

In the first stage, one or more muscles are repositioned with "slip knot" sutures. In the second phase, usually performed within the next 24 hours, the muscle(s) may be repositioned by untying and retying the knots under eyedrop anesthesia. In many cases, no adjustment is needed and the slip knot is converted to a standard knot. Adjustable sutures require good cooperation from the patient and may not be suitable for everyone.

What are the risks of strabismus surgery?

The risks of strabismus surgery are extremely low, but as with all surgery there are potential problems. These may include:

  • An unfavorable reaction to anesthesia;
  • Infection;
  • Reduced or double vision;
  • Inadequate eye alignment.


An adult does not need to live with misaligned eyes. Glasses, prisms, exercises, and other treatments can sometimes help. Surgery can be done to:

  • Align the eyes for cosmetic reasons;
  • Eliminate double vision;
  • Improve the use of the eyes together;
  • Reduce fatigue.

Advances in surgical techniques allow an excellent chance of successful alignment and improved appearance for most individuals.

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The physicians of Fritch Eye Care Center specialize in treating Bakersfield LASIK, glaucoma, and cataracts patients. Using cutting-edge technology in their state-of-the-art medical facilities, these Drs. are considered to be specialists in their field.

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