Surgery of Adult Strabismus

Strabismus, also known as lazy eye, is a condition involving the alignment of the eyes. The eyes do not properly align with each other. There can be a wide variety of severity in cases of strabismus. With strabismus, the extraocular muscles, responsible for bringing the eyes into alignment, are not properly working. Strabismus affects binocular vision and potentially depth perception. Present in about 4% of all children, strabismus should be treated as early as possible to prevent complications in vision. However, some adults continue to have strabismus whether treated as children and suffering from lingering affects of a severe condition or having never been treated. This condition can be related to the muscles of the eye as in paretic types when one or several extraocular muscles are paralyzed. There are other conditions responsible for this condition. A throrough exam by an opthamologist can determine the cause of the strabismus.

The Hirschberg test is a screening test where a flashlight is shone into the patient’s eye. The patient’s pupil will reveal a reflection that should be identical in both eyes. If not in the same place, the eyes are not aligned. Further evaluation includes a cover test. Used for diagnosis and measurement of the condition, this test can help guide treatment as well. The strabismic eye, also known as unilateral strabismus, or eyes, known as alternating strabismus, will be assessed by the direction of the deviation. Outward deviation is called exotropic whereas inwards towards the nose is called esotropic. These horizontal deviations are the most common. Less common vertical upward deviation is referred to as hypertropia and downward is called hypotropia.

The primary goal of treating adult strabismus is to enable the patient consistent, clear single binocular vision at all distances and from every direction. When detected in childhood and in its minor form, strabismus can usually be corrected through use of an eyepatch and eyeglasses which will allow the strabismic eye to self-correct. Depending on the severity of the amblyopia or lazy eye (the condition in which the brain ignores input from the strabismic eye) strabismus may need to be treated through a surgical procedure. This surgery will align the eyes by changing something about the eye muscles. Adult lazy eye surgery is often the only way to correct the cosmetic appearance.

If not treated early, before the age of 7, lazy eye may become a permanent condition in which the only option would be a surgical one. During one study, 85% of adults with strabismus reported problems affecting their work, school or leisure activities whereas a vast majority also claimed a negative effect on their self-image due to the altered appearance of a lazy eye.

The surgical procedure may last an hour and can take up to 2 weeks recovery. This surgery is often successful and lasting, although occasionally with a severe case, a second procedure may need to be done.

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