Deviated eyes also called as squint or strabismus is a condition in which the direction of eyes is misaligned. It may or may not be associated with poor vision in one or both eyes and double vision, also know as diplopia.

Historical Perspective

Over the past several generations it was felt that very little could be done for misaligned eyes in adults. Recently there has been a marked improvement in the outcome of treatment for these patients. Now the vast majority of misaligned eyes can be significantly improved.

The Value of treating strabismus

Over 4% of adults have misaligned eyes. Some are associated with medical illnesses or accidents. Adult-onset eye misalignment is usually accompanied by intolerable double vision, which prompts evaluation and treatment by strabismus specialists.

A second and more common type involves patients with childhood onset misaligned eyes. This problem starts at a time when a child can supress or “turn off” one eye thus avoiding the double vision that is present in adult onset strabismus. Unfortunately, for decades adults have been told that nothing could or should be done about their misaligned eyes. As a result, proper treatment has not been available to them.

These patients suffer from a loss of binocular vision and stereopsis. Many can have a limitation of their field of vision (peripheral or side vision). These patients have an automobile accident rate much higher than average possibly due to limitation of their field of vision.

In addition to affecting eye function, misaligned eyes can hamper normal eye-to-eye contact and thus interfere with communication and social interaction. This can lead to impaired self confidence and the development of abnormal head posturing during social interaction.

Patients with these problems will often learn to look down or look away from the person to whom they are speaking. The person being spoken to often is uncertain which eye the strabismus patient is using, leading to a major distraction from what the patient is trying to communicate.

This impairment of normal communication skills can lead to limited job and job advancement opportunities. Misalignment of the eyes is a deformity that handicaps an individual’s social and economic potential.

Straightening the eyes will lead to some helpful binocularity in the vast majority of cases, even in instances where the onset of the strabismus occurred in early childhood.

Strabismus repair is not a “cosmetic” procedure but should be considered more appropriately reconstructive surgery (changing an abnormal appearance to one that is more normal.) Cosmetic surgery alters a normal appearance (face lifts, etc.) Thus, insurance should cover the expense of diagnosis and treatment.

Double vision associated with realignment in cases where strabismus problems had their onset from childhood is usually transient, clearing in 2-3 weeks. The eyes usually require some time to adapt to the new, realigned position.

Patients who have adult onset strabismus with other medical problems and constant double vision before surgery may also continue to have some problems with double vision after surgery.

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Frequently asked questions

1) Is it true that nothing can be done about misaligned eyes in adults after a certain age?

Ans: No. There have been a number of advances in this field over the past several years that provide an opportunity to most of these patients to correct their misalignment.

2) Won’t straightening my eyes after all these years cause me to see double?

Ans: Double vision may occur after straightening eyes that have been out of alignment for many years. However, it is almost always a transient problem, lasting only a few weeks until the brain adapts to the new eye position.

3) I’ve been told that straightening my eyes at my age is strictly cosmetic.

Ans: That is incorrect. After eye alignment surgery, many adults improve eye function and most gain social and economic benefits.

4) Does my insurance cover the expense of squint surgery?

Ans: Although eye muscle surgery is not cosmetic surgery, you may want to check with your insurance carrier to determine their policy on this issue.

5) Isn’t eye surgery at my age risky?

Ans: The risk to your health or to your vision may vary with your general health. One in every several thousand may experience a significant complication. For those in poor health, there may be alternatives, such as surgery under local anesthesia (instead of general anesthesia) or the use of office Botox injections.

6) How successful is eye muscle surgery?

A: At least 7 of every 10 patients are successfully corrected with one surgery. In other patients, even after successful surgery, the alignment is transient and the eye may become deviated gradually again. These patients need a re-surgery to achieve realignment.

7) How painful is squint surgery?

Ans: Discomfort can vary with the individual. Most of the discomfort after eye muscle surgery is a foreign body sensation in the eye, which lasts for several days. Patients routinely say that it is less painful than other surgical procedures such as tonsillectomy, appendectomy or gall bladder removal. In most cases over-the-counter pain medication is adequate. Most patients are back to full activity in several days. Some surgeons suggest limiting swimming and heavy physical activity for a week or two after surgery.

8) Am I too old to have my eyes straightened?

Ans: Eyes can be straightened at any age. If you feel it will enhance your quality of life, you should consider it.

9) I am embarrassed by my misaligned eyes. I avoid looking people in the eye. They seem to be distracted by my wandering eye. As a result, communicating is difficult, hampering me socially and in getting the job I want. Am I being realistic or paranoid?

Ans: Recent studies have confirmed these observations. We feel misaligned eyes do hamper social interaction, self confidence and employment opportunities. We feel patients deserve straight eyes.

10) How can I find out more about getting my wandering eye treated?

Ans: You can contact a specialist in your area. These individuals have had special training in eye muscle problems. They are all qualified to treat these conditions in adults. Some specialists restrict their practices to children but can recommend a colleague who has a special interest in adults. Your own Eye M.D. may also have a recommendation.

11) Do I have to be hospitalized for eye alignment surgery? How will this affect my normal activities?

Ans: Generally eye alignment surgery is performed as an out-patient procedure, although the need for hospitalization may vary depending upon your general health and the preference of your surgeon. Following surgery most patients return to nearly all of their normal activities within a few days.

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