Understanding Strabismus in Adults: Causes, Diagnosis & Treatment

Welcome to Clarity Eye Surgeons in Canberra, where we are dedicated to optimising your eye health. Today, we are addressing an important topic: Strabismus in adults. Often seen as a condition of childhood, Strabismus can indeed affect adults too. This comprehensive guide aims to provide you with a deeper understanding of Strabismus in adults, its causes, treatment options, and how you can navigate this journey with confidence.

What is Strabismus in Adults?

Strabismus, also known as “crossed eyes” or “squint” is not limited to childhood. It is a condition where the eyes do not align properly. In adults, this misalignment can be constant or intermittent, causing one eye to turn inwards, outwards, upwards, or downwards while the other remains straight. The impact can extend beyond the physical; it affects daily life, self-esteem, and social interactions.

Causes of Strabismus in Adults

Strabismus in adulthood can have various causes, including:

  1. Childhood Onset: Strabismus that started in childhood and was not treated can persist into adulthood.
  2. Neurological Conditions: Conditions like stroke, head injuries, or brain tumours can affect the eye muscles and lead to Strabismus.
  3. Trauma or Injury: Any injury to the eye or eye muscles can cause misalignment.
  4. Thyroid Orbitopathy (Thyroid Eye Disease): An autoimmune condition can affect eye muscles and lead to Strabismus.
  5. Age-Related Changes: As we age, changes in the eye muscles can sometimes cause Strabismus to develop.

It i’s crucial to understand that Strabismus in adults is not a result of personal negligence or something you could have prevented.

Recognising Strabismus in Adults

Recognising Strabismus in adults requires paying attention to the following signs and symptoms:

  1. Squinting: Adults with Strabismus may frequently squint one eye to reduce double vision or achieve better alignment. This habit can be noticeable to others, especially in well-lit conditions.
  2. Inconsistent Eye Contact: If you find it challenging to maintain steady eye contact with others during conversations, it may be because one eye is misaligned, causing discomfort or self-consciousness.
  3. Eye Fatigue: Strabismus can lead to eye strain and fatigue, particularly after prolonged visual tasks like reading or using a computer. 
  4. Head Tilting or Turning: Similar to children, some adults with Strabismus may adopt a head tilt or turn to compensate for their misaligned eyes. This can be a subconscious adjustment to achieve better alignment and reduce double vision.
  5. Difficulty with Depth Perception: Strabismus can lead to impaired depth perception in adults. If you often misjudge distances or have difficulty with tasks that require accurate depth perception, such as pouring liquids or catching objects, this could be due to Strabismus.
  6. Interference with Daily Tasks: Strabismus can interfere with daily activities, such as reading, driving, or even watching TV. If you find yourself struggling with any of these activities due to visual discomfort or double vision, it’s essential to consider Strabismus as a potential factor.

If you experience any of these symptoms, it i’s essential to consult an eye doctor for a thorough evaluation.

Diagnosis and Evaluation in Adults

Diagnosing Strabismus in adults involves a comprehensive eye examination. This evaluation may include:

  1. Visual Acuity Test: To assess how well each eye sees.
  2. Cover Test: To detect eye misalignment.
  3. Refraction Test: To check for focusing errors.
  4. Eye Movement Assessment: To determine the extent of the misalignment.

In some cases, additional tests like imaging or blood tests may be needed to identify the underlying cause of Strabismus.

Treatment Options for Strabismus in Adults

Treatment for Strabismus in adults can significantly improve eye alignment and overall quality of life. Treatment options may include:

Eyeglasses with Prisms:

Eyeglasses with prisms are a non-invasive treatment option for adults with Strabismus. They are particularly effective for individuals with small angle misalignments of the eyes.

Botox Injections:

Botox (Botulinum toxin) injections are a treatment option for Strabismus, primarily used when eye muscle surgery is not suitable or not preferred. 

Here is a detailed look at Botox injections as a treatment for Strabismus in adults:

How Botox Injections Work:

Botox works by temporarily weakening specific eye muscles, which helps alleviate the misalignment of the eyes.

The Procedure:

Botox injections for Strabismus are performed in a clinical setting by an ophthalmologist (eye surgeon).

The doctor will administer the Botox solution into the targeted eye muscle using a fine needle. Multiple injections may be necessary, depending on the severity of Strabismus.

Local anaesthesia or numbing drops are often applied to minimise discomfort during the procedure.

Effects and Duration:

The injected Botox temporarily weakens the treated eye muscle, allowing the opposing muscle to become more dominant and align the eyes.

The effects typically become noticeable within a few days to a week after the injection.

Botox effects are temporary, usually lasting around three to four months. Therefore, repeat injections may be required to maintain eye alignment

Considerations and Risks:

Botox injections are generally safe, but like any medical procedure, they carry some risks, including (but not limited to) temporary drooping of the eyelid, new double vision, or mild discomfort.

It is crucial to follow the post-injection care instructions provided by your ophthalmologist.

Surgical Correction

Surgical correction of Strabismus with eye muscle surgery in adults is often recommended, either when other treatment options are ineffective or in cases where the misalignment is severe or constant. 

Here is a detailed look at surgical corrections for Strabismus:

Surgical Approach:

Strabismus surgery involves adjusting the length or position of eye muscles to achieve improved eye alignment.

The procedure is typically performed under general anaesthesia, ensuring the patient feels no pain during the surgery.

Preoperative Evaluation:

Prior to surgery, a thorough preoperative evaluation is conducted to determine the extent of Strabismus and plan the surgical approach.

The ophthalmologist will discuss the procedure, potential risks, and expected outcomes with the patient.

The Surgical Procedure:

During the surgery, small incisions are made in the conjunctiva (the clear tissue covering the white of the eye) to access the eye muscles.

The eye surgeon adjusts the length or position of the muscles, usually with the help of sutures, to align the eyes correctly.

The incisions are closed with dissolvable sutures.

Recovery and Postoperative Care:

After surgery, patients may experience mild discomfort, redness, and swelling around the eyes. Pain can usually be managed with over-the-counter pain relievers.

The eyes may appear red or bloodshot for a few weeks, but this typically resolves.

Patients are advised to follow postoperative instructions carefully, including using prescribed eye drops and attending follow-up appointments.

Expected Outcomes:

Strabismus surgery is often highly successful in achieving better eye alignment.

Patients typically notice improved eye coordination and a reduction in double vision.

Risks and Considerations:

While complications are rare, as with any surgery, there are some potential risks, including (but not limited to) over-correction or under-correction, infection, or scarring.

It is essential to discuss the surgical procedure, expected outcomes, and potential risks thoroughly with your ophthalmologist before making a decision.

The Importance of Seeking Treatment as an Adult

Seeking treatment for Strabismus in adulthood is essential for several reasons:

  1. Improved Quality of Life: Treatment can significantly enhance your daily life by reducing double vision, eye strain, and discomfort.
  2. Self-Confidence: Aligned eyes can boost your self-esteem and improve social interactions.
  3. Functional Vision: Properly aligned eyes may enable better depth perception and eye-hand coordination.

Your Role as a Patient

Taking an active role in your treatment journey is crucial. Be sure to:

  1. Attend all scheduled appointments.
  2. Follow your prescribed treatment plan diligently.
  3. Communicate openly with your healthcare professionals.


In conclusion, Strabismus in adults is treatable, and seeking treatment can improve your quality of life. 

If you have concerns about your eye alignment or suspect Strabismus, contact Clarity Eye Surgeons today to schedule an appointment. We are committed to helping you achieve the best possible outcome for your eye alignment.

Author Bio

Dr Parth Shah is a director and principal ophthalmologist at Clarity Eye Surgeons in Canberra, specialising in strabismus surgery and cataract surgery. With extensive training and experience, he is renowned for his expertise in the field. Dr Shah is dedicated not only to performing successful surgeries but also to patient education. His compassionate approach, combined with technical proficiency, has earned him the trust and gratitude of countless patients. He is a true advocate for eye health and a trusted name in the Canberra ophthalmology community.

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