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How is strabismus treated?

A minimally invasive surgical technique to correct the double vision and crossed eyes in people with strabismus — performed under topical anesthesia with the patient awake — enables a patient to gauge the results while still in the operating room so that the surgeon can make any adjustments as necessary to ensure the best outcome.

Strabismus, in which the eyes fail to line up in the same direction when focusing, is the major cause of double vision in older adults. In the past, people with strabismus at a large enough angle have been treated with surgery under general anesthesia to manipulate the eye muscles in an effort to correct the problem. Since the result couldn’t be determined until the person was awake, a second procedure was often required in an effort to achieve the desired outcome.

People with small-angle strabismus, or whose general health makes them poor candidates for major surgery, have used thick and cumbersome prismatic glasses to manage their symptoms. Says Joseph Demer, MD, PhD, ophthalmologist at UCLA’s Jules Stein Eye Institute, "These glasses are sometimes effective and sometimes not, and even when they do help, the ability to free people with strabismus from being dependent on prisms -- especially since many have had cataract and laser surgery so that they don’t need spectacles other than for their double vision -- is a major benefit."

The traditional surgical methods tended to “overshoot” the correction for people with small angles of displacement, essentially giving them double vision in the other direction. With the minimally invasive procedure, instead of detaching the eye muscle completely, the doctor can partially trim the tendons of the muscle, allowing the remaining tendons to stretch so that smaller angles of misalignment can be treated more reliably. All of this is done in 15-20 minutes, without the grogginess and bandages that come with general anesthesia. "It’s like getting a filling at the dentist -- you can go right back to your normal activities later that day," says Dr. Demer.

In some situations, glasses are a very effective treatment for strabismus. In others, glasses have little or no effect on eye alignment; it all depends on the diagnosis. Contacts will improve eye alignment if glasses have helped, but they will offer little or no improvement if glasses have not been of benefit.

Unfortunately, the need for re-operation after strabismus surgery is not uncommon. A discussion with your eye doctor may be helpful in helping you to better understand your medical and surgical options.

After a complete eye examination, an ophthalmologist can recommend appropriate treatment.

In some cases, eyeglasses can be prescribed for your child to straighten the eyes. Other treatments may involve surgery to correct the unbalanced eye muscles or to remove a cataract. Covering, blurring or patching the strong eye to improve amblyopia is often necessary.

Treatment for strabismus works to straighten the eyes and restore binocular (two-eyed) vision.

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