Strabismus Treatment in Adults: Why It Is Not Just a Childhood Operation

The photograph was fine until she zoomed in. One eye looked straight at the camera; the other had drifted outward, the way it had started to do in meetings, at dinner, in the mirror at the end of a long day. She had been told at nine that her “lazy eye” was fixed. Thirty-four years later, here it was again, and the first thing she felt was embarrassment about even asking.

That reaction is common, and it is worth challenging. Eye misalignment that appears, persists or returns in adult life is a medical condition with medical treatments, and strabismus surgery in adults is neither rare nor unusual. It is, however, surrounded by hand-me-down beliefs: that it is only for children, that it is purely cosmetic, that the muscles are somehow “set” by adulthood.

This explainer walks through what the evidence actually says about adult eye misalignment, what the operation involves, who is usually offered it, what recovery looks like and which alternatives exist, so that your conversation with your care team starts from facts rather than folklore.

How many people have strabismus, and why are so many of them adults?

Strabismus is the medical term for eyes that do not line up with each other; one eye may turn in, out, up or down while the other looks straight ahead. Most people picture a toddler when they hear the word, and the childhood numbers are indeed high: the NHS estimates that about 1 in 20 children has a squint, the British term for the same condition.

What surprises people is how many adults are affected. Roughly 4% of adults in the United States live with some degree of strabismus, according to Cleveland Clinic. That figure is a mix of three groups. Some carried misalignment from childhood, treated or untreated. Some had a good result from childhood treatment that gradually loosened over decades, because the brain’s ability to hold the eyes together can weaken with age. And a substantial share developed strabismus for the first time as adults, usually because of a nerve problem, an injury, a thyroid disorder or another medical cause rather than anything present at birth.

This matters because it reframes the question. If nearly one adult in twenty-five has misaligned eyes, the condition is not a childhood leftover that somebody forgot to fix. It is a common adult eye problem, and eye departments treat it as one. Johns Hopkins notes that adults with strabismus are evaluated by ophthalmologists with specific training in eye movement, the same specialists who see children, because the underlying anatomy and the surgical principles are shared across ages.

The scale also explains why adult strabismus deserves clearer public information than it gets. Many adults quietly assume nothing can be done, or that asking would be vanity. Neither belief is supported by the evidence.

What causes strabismus to appear or come back in adulthood?

Six small muscles attach to the outside of each eyeball and swing it in every direction. Three cranial nerves, numbered three, four and six, carry the brain’s instructions to those muscles. Alignment depends on all of that working in concert, so anything that disturbs a muscle, a nerve or the brain’s control system can knock the eyes out of step.

In adults, MedlinePlus and Cleveland Clinic list several recurring culprits. Damage to one of the eye-movement nerves is a frequent one, and its causes range from diabetes and high blood pressure affecting small blood vessels to head injury, stroke or, rarely, pressure from an aneurysm. Thyroid eye disease, in which the immune system inflames and stiffens the eye muscles, is another; the thickened muscle physically restricts movement. Injury to the eye socket, such as a fracture of the thin bone beneath the eye, can trap a muscle. Neurological conditions including myasthenia gravis, multiple sclerosis and Parkinson’s disease can also produce misalignment. Occasionally strabismus follows other eye surgery, cataract or retinal procedures among them.

Then there is the group with a childhood history. A person whose eyes were straightened at six may find that in their fifties the drift returns, often as an outward turn that worsens with fatigue. Nothing has gone wrong; the compensating effort the brain has been making for decades simply becomes harder to sustain, much as reading small print does.

Because the causes range from benign to urgent, a new adult misalignment is never diagnosed by appearance alone. The examining doctor looks for the pattern of the deviation, whether it changes with gaze direction, and what else is going on in the body. The reason matters, and it steers every treatment decision that follows.

What is vertical strabismus in adults?

Most people know horizontal misalignment: an eye that turns inward (esotropia) or outward (exotropia). Vertical strabismus is different. One eye sits higher than the other, a state called hypertropia, or lower, called hypotropia. Because the two images are stacked rather than side by side, people describe seeing “one thing on top of another” or a step in a straight line such as a door frame.

Vertical misalignment is proportionately more common in adults than in children because its usual causes are acquired. Weakness of the fourth cranial nerve, which controls the muscle that pulls the eye down and inward, is a classic example; it can follow even a minor head bump or arise from reduced blood supply in people with diabetes or high blood pressure. Thyroid eye disease tends to tether the muscle beneath the eye, dragging that eye downward. A fracture of the orbital floor can do the same mechanically. Certain brain stem or balance-system disorders produce a related pattern called skew deviation.

People with vertical strabismus often tilt or turn their head without realizing it. The tilt is not a habit; it is the brain finding the one head position in which the images fuse. Over months this can cause neck ache, and family members sometimes notice the posture before the person notices the double vision.

Because even a small vertical difference produces troublesome double vision, vertical strabismus is a frequent reason adults seek care. Treatment options are the same family as for horizontal misalignment, prisms, injections and surgery, but the surgical plan targets the vertically acting muscles and is usually tailored after careful measurements in different gaze positions. The examining specialist will also want to rule out any neurological cause before anything is scheduled.

Is adult strabismus only a cosmetic problem?

No, and this misunderstanding does real harm because it stops people asking for help. The visible turn is only the part other people see. What the person experiences depends heavily on when the misalignment started.

Someone whose eyes drifted in early childhood often had the brain “switch off” the image from the wandering eye to avoid confusion, a process that leads to amblyopia, reduced vision in that eye. As adults they may not see double, but they may lack stereoscopic depth perception and may have a narrower field of view because the eyes overlap less than they should. An eye turned inward, for example, effectively shrinks the visual world on that side.

Someone whose eyes misaligned in adulthood has a mature visual system that cannot suppress an image. The result is diplopia, double vision, which MedlinePlus describes as the hallmark symptom of adult-onset strabismus. Reading, driving, walking on stairs and pouring a drink all become harder. Many adults also report eye strain, headaches, and the neck discomfort that comes from holding a compensating head posture all day.

Then there is the social dimension, which clinicians increasingly take seriously. Eye contact is the currency of conversation and, according to Cleveland Clinic, adults with misaligned eyes frequently describe avoiding it, feeling misread as inattentive, or being asked which eye to look at. Johns Hopkins notes that restoring alignment is regarded as reconstructive, not cosmetic, in the same way that repairing a drooping eyelid that blocks vision is.

The distinction matters medically as well as emotionally. Double vision, a restricted field and a forced head tilt are functional problems, and functional problems are treated on their merits at any age.

How strabismus surgery in adults actually works

The operation sounds more alarming than it is, largely because people imagine the eye being removed. It is not. The surgeon reaches the muscles through a small opening in the conjunctiva, the thin transparent membrane covering the white of the eye; the eyeball itself stays in the socket throughout.

Once a muscle is exposed, there are two basic moves. A recession weakens a muscle by detaching it from its original spot and reattaching it slightly farther back, so it pulls less. A resection strengthens a muscle by shortening it before reattaching it, so it pulls more. An eye turning outward, for instance, might have its outer muscle recessed and its inner muscle resected. Vertical and rotational problems use the same principles on the vertically acting muscles. Several muscles, and sometimes both eyes, may be addressed in one session, even if only one eye appears to wander, because alignment is a two-eye system.

Adults are usually offered a choice between general anesthesia and local anesthesia with sedation, MedlinePlus notes. The NHS describes the operation as typically taking under an hour, although complex cases with multiple muscles or scarring from earlier surgery run longer.

One technique is particularly relevant to adults: adjustable sutures. The surgeon ties the muscle with a knot that can be loosened or tightened after the patient is awake, usually within hours, while the patient looks at a target. This lets the team fine-tune the position based on the actual result rather than a prediction. MedlinePlus lists this as an option often used in adults, who can cooperate with the adjustment in a way small children cannot.

Dissolvable stitches close the conjunctiva. Almost everyone goes home the same day.

Who is usually offered strabismus surgery in adults, and who is asked to wait?

Surgery is a tool for a specific job: moving eyes that are stably misaligned into a better position. The first question a specialist asks is therefore whether the misalignment is stable and whether its cause has been sorted out.

Adults commonly offered surgery include those with long-standing misalignment from childhood, with or without earlier operations, whose deviation is too large for prisms; those with double vision that prisms cannot comfortably correct; those with a restrictive problem such as thyroid eye disease once the inflammation has settled; and those whose forced head posture is causing neck symptoms. Cleveland Clinic also notes that surgery is considered when a wide-angle deviation narrows the field of vision or when misalignment materially affects social functioning.

Others are usually asked to wait, and the reasons are sound rather than dismissive. A new nerve palsy, for example, frequently improves on its own; guidance summarized by MedlinePlus and Johns Hopkins is to allow several months of observation and repeated measurements, because operating on a moving target risks over- or under-correction. Active thyroid eye disease is similar: muscles still swelling will change position after surgery, so surgeons generally wait until the disease has been quiet and the measurements stable. Uncontrolled diabetes or blood pressure, an unexplained neurological picture or an untreated underlying condition all warrant investigation and stabilization first.

A separate group is asked to consider whether surgery is the right tool at all: adults with a very small deviation who are well served by prism glasses, or adults whose main complaint is blurred vision from amblyopia, which surgery does not improve.

In every case the recommendation comes from the examining team after measurements taken on more than one visit. A single consultation rarely ends with a surgical date.

What are the alternatives to surgery for adult eye misalignment?

Surgery is not the only route, and for many adults it is not the first. Three non-surgical approaches recur in guidance from the NHS, MedlinePlus and Cleveland Clinic.

Prism glasses are the workhorse. A prism is a wedge of lens that bends incoming light, shifting the image toward the eye’s actual position so the brain receives two matching pictures. Temporary press-on prisms, a thin plastic film applied to an existing lens, let the team test a strength before grinding a permanent prism into the glasses. Prisms work best for small, stable deviations and for double vision that is the same in all gaze directions. Their limitation is optical: large prisms are heavy, distort the edge of the image and can blur.

Injection of botulinum toxin into an overacting eye muscle is a second option. The toxin blocks the nerve signal at the muscle, temporarily weakening it so the opposing muscle can pull the eye toward the middle. Its effect wears off over months, which makes it useful as a diagnostic trial, as a bridge while a nerve palsy recovers, or for people who are not candidates for anesthesia. It can also cause temporary drooping of the eyelid or an overcorrection while it is active. Whether it suits an individual, and how often, is a decision for the treating ophthalmologist.

Eye exercises, sometimes marketed as vision therapy, have a narrower evidence base than their reputation suggests. They can help one specific problem, convergence insufficiency, where the eyes struggle to turn inward for reading. The NHS and Cleveland Clinic do not list exercises as a treatment for other forms of adult strabismus, and no exercise program has been shown to straighten a large or paralytic deviation.

Simply covering one eye with a patch or frosted lens removes double vision and remains a reasonable choice for some people.

Adult strabismus treatment options compared

The table below summarizes how the main options differ in what they do and where they fit. It is a map for your conversation, not a menu; which square applies to you depends on measurements only your care team can take.

Option	How it works	Usually considered when	Main limitations
Observation	Repeated measurements while a cause resolves	Recent nerve palsy or active inflammation	Symptoms persist during waiting period
Prism glasses	Bend light so images match despite misalignment	Small, stable deviation; double vision	Heavy or blurry at high powers; do not move the eye
Occlusion (patch or frosted lens)	Blocks one image to remove double vision	Temporary relief; when other options unsuitable	Loses depth perception and field on that side
Botulinum toxin injection	Temporarily weakens an overacting muscle	Trial of effect; bridging; anesthesia concerns	Wears off over months; lid droop possible
Eye muscle surgery	Repositions or shortens muscles permanently	Large or persistent deviation; prisms insufficient	Surgical risks; second procedure sometimes needed

Two points deserve emphasis. First, these are not rivals; they are often combined. A person may wear prisms while waiting for a palsy to stabilize, have surgery, and then use a small prism to tidy a residual deviation. Second, only surgery changes where the eye physically rests. Prisms and patches change what the brain receives; the eye itself stays where it was. That is why appearance, field of view and head posture generally improve only with surgery or injection, while double vision can improve with any of them.

The MedlinePlus and NHS overviews describe each of these approaches in more detail, and both emphasize that the plan is individualized after measurement.

Is strabismus surgery worth it for adults? What the evidence says

People asking this usually want a percentage. Honest answer: a single headline number would mislead, because “success” means different things to different patients and studies define it differently.

What the evidence supports, as summarized by MedlinePlus, is that eye muscle surgery generally improves alignment and that a proportion of people need a second operation to reach the desired position. Johns Hopkins and Cleveland Clinic describe surgery as effective in adults across the age range, including older adults, and both note that many adults have been wrongly told nothing could be done. Adjustable sutures are one reason adult outcomes have improved; they let surgeons correct in the recovery area rather than waiting months to see how the eyes settle.

Where the evidence is more cautious is in what surgery cannot do. It does not sharpen vision in an amblyopic eye; Mayo Clinic notes that amblyopia treatment is most effective in childhood, and adults should not expect surgery to change acuity. Depth perception may improve in adults whose misalignment began after their visual system matured, but adults who never developed stereoscopic vision usually do not gain it. Double vision from adult-onset strabismus often improves substantially when the eyes are realigned, though a small residual deviation may still need a prism.

The gains that adults themselves rate most highly, in published patient-reported outcome studies indexed in PubMed, tend to be functional and social: easier eye contact, fewer headaches, a wider field, relief from head tilt. Those benefits are real but harder to reduce to a statistic.

So is it worth it? For an adult with double vision, a restricted field, a forced head posture or distress about alignment, and a stable deviation that prisms cannot manage, the evidence supports surgery as a reasonable, mainstream option. Whether it is worth it for you is a weighing of your symptoms against the risks in the section below, done with your surgeon.

Adult strabismus surgery recovery: what the days and weeks usually look like

The first thing most people notice on waking is that the eye feels gritty, as though an eyelash is trapped, and that the white of the eye has turned deep red where the muscle was reached. Both are expected. The NHS describes soreness that is generally manageable with ordinary pain relief chosen with your care team, and redness that fades gradually over weeks rather than days.

Day one to three: rest at home. The eye may water and the lids may swell. Many people see double intermittently during this period, MedlinePlus notes, because the brain is re-learning where the eye now points; this usually settles as the swelling goes down. If adjustable sutures were used, the adjustment typically happens the same day or the following morning before you are discharged from follow-up.

The first week: the NHS advises that most people can return to work or study within a few days to a week, depending on the job. Reading and screens are allowed as comfort permits; they do not damage the repair. Rubbing the eye is the one thing to avoid, since the muscle is held by stitches that need time to be replaced by natural healing. Drops prescribed by the surgical team to prevent infection and calm inflammation are used as directed; do not stop them early without asking.

Weeks two to six: redness continues to fade, the dissolvable stitches disappear, and the eye’s final resting position becomes clearer. The NHS advises avoiding swimming for a few weeks and keeping soap and shampoo out of the eye. Driving resumes when double vision has resolved and you meet your local vision standard, which your team can confirm.

Follow-up appointments, usually within the first week and again after several weeks, are where alignment is measured and any need for a small prism or, less commonly, a further procedure is discussed. Individual recovery varies with age, the number of muscles operated and any previous surgery.

What are the risks of strabismus surgery in adults?

Every operation carries risk, and the adult version of this one carries a few that are specific to the eye. Neutral information from MedlinePlus, the NHS and Cleveland Clinic lists the following.

The most common issue is imperfect alignment: the eye ends up under-corrected or over-corrected. This is not a failure of technique so much as a limit of prediction, because each person’s muscles and brain respond differently. It is the main reason a second operation is sometimes needed, and adjustable sutures exist to reduce it. Double vision may appear after surgery in someone who did not have it before, particularly adults whose brain had adapted to a long-standing turn; it is usually temporary but can occasionally persist and need a prism.

Less common risks include infection, bleeding, and scarring of the conjunctiva that leaves a visible pink area or restricts movement. A muscle can slip from its new attachment, which requires reoperation. Very rarely, the needle used to reattach a muscle can perforate the eye wall. Adults who have had several previous operations face higher technical difficulty because of scar tissue.

The anesthetic carries its own risks, which the anesthesia team assesses individually, and there is a specific reflex during eye muscle surgery, the oculocardiac reflex, that can slow the heart rate; anesthetists watch for and manage it as a matter of routine.

Two things are not risks of the operation despite persistent worry: it does not blind people in any ordinary course of events, and it does not weaken the eye in later life.

Balanced against these are the risks of not treating: continuing double vision, worsening neck strain, narrowed field and the social burden. Your surgeon should put both columns in front of you before you decide.

Does insurance cover strabismus surgery for adults?

This is one of the most searched questions about adult strabismus, and the answer is more encouraging than many people expect, with an important caveat about paperwork.

The medical framing is what matters to insurers. Johns Hopkins and Cleveland Clinic both describe adult strabismus surgery as reconstructive rather than cosmetic, because it treats a functional problem: double vision, loss of visual field, abnormal head posture, or eye strain. Health plans in the United States generally distinguish reconstructive procedures, which restore function, from cosmetic ones, which alter normal appearance, and eye muscle surgery falls squarely in the first category when there is documented misalignment on examination.

In practice, coverage decisions rest on documentation. The examining ophthalmologist records the measured deviation, the symptoms it causes and the treatments already tried, such as prisms. Some plans require prior authorization, meaning approval before the operation is scheduled. This is administrative rather than a judgment on whether you deserve treatment, and clinic staff who handle such requests routinely can tell you what your plan requires.

Because plan rules vary widely, no article can tell you what your policy covers. The reliable step is to ask your insurer directly, quoting the procedure your surgeon has recommended, and to ask the clinic whether they have handled requests with your plan before. People covered by government programs and by employer plans alike are usually treated under the reconstructive rules described above, but only your own plan documents are definitive.

One further point: the belief that adult strabismus is “cosmetic” originated partly from insurers decades ago, and it lingers in public memory. Modern clinical guidance from the sources cited here does not support that framing, and neither, in most cases, does current coverage policy.

What people often get wrong about adult strabismus

Myths about eye misalignment are unusually durable, perhaps because most of us last thought about it in childhood. Here are the ones clinicians hear most often, with what the evidence actually shows.

“It’s too late once you’re an adult.” The muscles can be repositioned at any age; there is no biological deadline. What does have a window is amblyopia treatment, the sharpening of vision in a suppressed eye, which Mayo Clinic notes is far more effective in childhood. Alignment and acuity are separate goals, and only the second is age-limited.

“Surgery will fix my vision.” It will move the eye. It will not change a prescription, and it will not give sharp sight to an amblyopic eye. Realistic expectations prevent disappointment.

“Eye exercises can straighten any turn.” Exercises have evidence for convergence insufficiency and little for anything else. No exercise program straightens a paralytic or large-angle deviation, and delaying evaluation while trying one can allow a treatable cause to progress.

“If I had surgery as a child, it can’t be done again.” Repeat surgery is common and expected. Scar tissue makes it more intricate, which is one reason it is done by eye-movement specialists, but earlier operations do not rule it out.

“An eye turn in an adult is just a leftover from childhood.” Sometimes. Frequently it is new and signals something else, from diabetes to thyroid disease to, rarely, a neurological emergency. New misalignment is a reason to be examined, not reassured.

“They take the eye out to operate.” They do not. The eye stays in the socket; the muscles are reached through the surface membrane.

“It’s vanity.” Wanting to look someone in the eye, drive safely and read without a headache is not vanity. Every major source cited here classifies the treatment as functional.

Questions to ask your care team about strabismus surgery in adults

A good consultation leaves you knowing why a particular plan was chosen for you rather than for a textbook patient. These questions tend to draw out that reasoning. Take them written down; it is easy to forget in the room.

• What is causing my misalignment, and has anything that needs separate treatment been ruled out?
• Is my deviation stable enough to operate on now, or should we measure again after an interval?
• Which muscles would you operate on, in which eye or eyes, and why that combination?
• Would adjustable sutures be used in my case, and how does the adjustment work?
• What is the realistic goal for me: relief of double vision, wider field, better alignment, or all three?
• What would surgery not change about my vision?
• How likely is it that I would need a second procedure, and what would prompt one?
• Have prisms or an injection been considered first, and why or why not?
• What anesthesia do you recommend for me and what does that depend on?
• What should I expect in the first week, and when can I drive, work and exercise?
• Which symptoms after surgery should make me call immediately?
• How many follow-up visits are usual, and what is measured at each?

Two further questions are fair to ask any surgeon: how often they perform adult strabismus surgery, and whether your case has features that make it more complex than average, such as previous operations, thyroid disease or a vertical component. Neither question is rude; specialists expect them.

If something you are told does not match what you read here or elsewhere, say so. Guidance is general and your eyes are specific; a good team will explain the difference rather than dismiss the question. The final plan should be one you understand and have agreed to, with the decision resting with you and the treating team together.

When to call your doctor

Two situations need prompt attention: a misalignment or double vision that appears suddenly in an adult, and certain symptoms after surgery. Neither should wait for a routine appointment.

Before any treatment. Double vision that begins abruptly, especially if it comes with a severe headache, a drooping eyelid, a pupil that looks larger than the other, weakness or numbness in the face or limbs, difficulty speaking, or loss of balance, is treated as an emergency. The NHS and Cleveland Clinic both advise urgent assessment in this situation, because a sudden palsy of the third cranial nerve can be a sign of an aneurysm and sudden misalignment can accompany a stroke. Call emergency services or go to the nearest emergency department. New double vision without those features still warrants a same-week appointment with your doctor or an eye specialist rather than watchful waiting, particularly if you have diabetes, high blood pressure or a thyroid condition.

After surgery. Contact the surgical team the same day if you have pain that is worsening rather than easing or is not controlled by the relief you were advised to take; increasing redness, swelling or a yellow or green discharge; a sudden drop in vision; new or worsening double vision after it had settled; a fever; or a sensation that the eye will not move in one direction. A slipped muscle, an infection or, rarely, a perforation all present in the first days and are far better addressed early. Mild grittiness, watering, pink discoloration and intermittent double vision in the first week are expected and are not on this list, but if you are unsure, call; teams would rather hear from you.

Keep the after-hours contact number you were given somewhere you can find it, and take a companion’s help in the first day if your vision is unsteady.

Frequently asked questions

Is strabismus surgery worth it for adults?

For many adults with a stable misalignment that causes double vision, a narrowed field, a forced head tilt or distress about appearance, mainstream guidance supports surgery as a reasonable option. It generally improves alignment, though some people need a second procedure and a residual prism. It does not improve sharpness in an amblyopic eye. Whether it is worth it for you depends on your symptoms weighed against the risks with your surgeon.

What is vertical strabismus in adults?

Vertical strabismus means one eye sits higher (hypertropia) or lower (hypotropia) than the other, so images appear stacked rather than side by side. In adults it is often caused by fourth cranial nerve weakness, thyroid eye disease or an orbital fracture. People frequently tilt their head to fuse the images. Treatment uses the same options as horizontal misalignment, targeted at the vertically acting muscles after careful measurement.

How many people have strabismus?

The NHS estimates about 1 in 20 children has a squint, and Cleveland Clinic puts adult prevalence at roughly 4% of adults in the United States. The adult group includes people whose childhood misalignment persisted or returned and a substantial number who developed strabismus for the first time in adulthood from nerve, thyroid, injury or neurological causes.

Does insurance cover strabismus surgery for adults?

Often, because major clinical sources classify adult strabismus surgery as reconstructive rather than cosmetic when it treats double vision, field loss or abnormal head posture. Coverage still depends on your specific plan and usually on documentation of the measured deviation and its symptoms; some plans require prior authorization. Ask your insurer directly and ask the clinic what your plan typically needs.

Can strabismus be treated in adults without surgery?

Yes, in suitable cases. Prism glasses bend light so the brain receives matching images and work well for small, stable deviations. Botulinum toxin injected into an overacting muscle temporarily weakens it and can serve as a trial or bridge. Patching removes double vision. Eye exercises help only convergence insufficiency. Which option fits depends on the size, cause and stability of the misalignment, assessed by an eye specialist.

How long does adult strabismus surgery recovery take?

Most people go home the same day, return to work within a few days to a week according to the NHS, and see redness fade over several weeks. Intermittent double vision in the first days is common as the brain adjusts. Swimming is usually avoided for a few weeks. Final alignment is judged at follow-up visits over the following weeks, and timelines vary with the number of muscles operated and any prior surgery.

Will strabismus surgery improve my vision?

It changes where the eye points, not how sharply it sees. Double vision from adult-onset misalignment often improves when the eyes are realigned, and field of view may widen. Vision reduced by amblyopia from childhood does not sharpen, because that treatment is most effective in early life. Adults who never developed depth perception usually do not gain it, though those who lost it in adulthood may.

Can adult strabismus surgery be repeated if I had it as a child?

Yes. Repeat surgery is common and expected in adults whose childhood correction has drifted over the decades. Scar tissue from earlier operations makes the procedure more intricate, which is why it is performed by ophthalmologists specializing in eye movement, but previous surgery does not rule it out. Your surgeon will want records of what was done before if available.

What causes an adult to suddenly develop a squint or double vision?

Common causes are weakness of one of the nerves controlling eye movement, often linked to diabetes or high blood pressure, thyroid eye disease, head or orbital injury, and neurological conditions such as myasthenia gravis or stroke. Because a few causes are urgent, sudden double vision, particularly with headache, a drooping lid or weakness, needs emergency assessment rather than a routine eye appointment.

What are adjustable sutures in strabismus surgery?

They are stitches tied with a slipknot so the surgeon can move the muscle slightly forward or back after the patient is awake, usually within hours of the operation, while the patient looks at a target. MedlinePlus lists them as an option often used in adults, who can cooperate with the adjustment. They aim to reduce under- and over-correction, though a further procedure is still occasionally needed.

References

• MedlinePlus Medical Encyclopedia: Strabismus
• MedlinePlus Medical Encyclopedia: Eye muscle repair
• NHS: Squint
• Cleveland Clinic: Strabismus (Crossed Eyes)

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.