Adult Strabismus & Diplopia

Strabismus isn't just a childhood condition. Adults can experience eye misalignment at any age, whether it has been present since childhood or develops later in life.

For some adults, strabismus causes double vision (diplopia), difficulty with depth perception, eye strain, or abnormal head positioning. Others may have lived with visibly misaligned eyes for decades without realizing that treatment is possible.

At Children's Eye Care, our fellowship-trained pediatric ophthalmologists and adult strabismus specialists specialize in diagnosing and treating strabismus in both children and adults. Our physicians work closely with certified orthoptists who have advanced training in eye alignment, binocular vision, and double vision.

Whether your eye misalignment is new or you've lived with it for years, treatment options may be available.

What Is Adult Strabismus?

Strabismus is a condition in which the eyes do not point in the same direction.

One eye may turn inward (esotropia), outward (exotropia), upward (hypertropia), or downward (hypotropia). The misalignment may be constant or intermittent and can affect one or both eyes.

Some adults have strabismus that began during childhood. Others develop eye misalignment later due to changes in eye muscle control, nerve disorders, medical conditions, injuries, or previous eye surgery.

Adult strabismus can affect visual function, comfort, and quality of life. However, having strabismus for many years does not mean it is too late to seek treatment.

What Is Diplopia (Double Vision)?

Diplopia is the medical term for double vision, which occurs when a person sees two images of a single object.

When the eyes are properly aligned, the brain normally combines the images from both eyes into one. If the eyes become misaligned, the brain may receive two images that do not correspond, resulting in double vision.

Double vision may be:

• Horizontal: Images appear side by side.

• Vertical: One image appears above the other.

• Diagonal: Images appear separated both horizontally and vertically.

• Intermittent: Double vision occurs only at certain times or in certain gaze positions.

• Constant: Double vision is present much or all of the time.

Double vision can be particularly disruptive when reading, driving, walking, or performing everyday activities.

Is Double Vision Always Caused by Strabismus?

No. Double vision has several possible causes.

Binocular diplopia typically resolves when either eye is covered and is often associated with eye misalignment.

Monocular diplopia persists when the affected eye is viewing alone and may be caused by conditions involving the cornea, lens, or other structures of the eye.

Distinguishing between these forms is an important part of determining the appropriate evaluation and treatment.

Sudden-onset double vision should be evaluated promptly. Double vision accompanied by severe headache, weakness, difficulty speaking, new drooping eyelid, or other neurological symptoms requires emergency medical evaluation.

What Causes Strabismus in Adults?

Adult strabismus can develop for several reasons, including:

• Childhood strabismus: Eye misalignment that was never corrected or returns years after treatment.

• Decompensated strabismus: A previously controlled eye alignment problem becomes more noticeable or causes double vision.

• Cranial nerve palsies: Conditions affecting the nerves responsible for eye movements.

• Thyroid eye disease: Changes in the tissues and muscles surrounding the eyes that may restrict movement.

• Neurological conditions: Certain disorders affecting the brain or nervous system can interfere with eye alignment.

• Injury or trauma: Head injuries or orbital fractures may affect eye movements.

• Previous eye surgery: Some patients develop eye misalignment following retinal, orbital, or other eye procedures.

• Reduced vision in one eye: Longstanding vision loss can sometimes contribute to eye drifting.

Because treatment depends on the underlying cause, a comprehensive evaluation is essential.

Can Adult Strabismus Be Corrected?

Yes. Adults of many ages can benefit from treatment for eye misalignment.

One of the most common misconceptions is that strabismus must be corrected during childhood or it cannot be treated later.

Although childhood is an important period for visual development, adults can still experience meaningful improvements in eye alignment, double vision, visual comfort, and quality of life.

Treatment options depend on the type and severity of strabismus, the patient's symptoms, and the underlying cause.

How Is Adult Strabismus and Double Vision Evaluated?

At Children's Eye Care, adult strabismus evaluations involve specialized measurements and a comprehensive examination.

Our certified orthoptists work closely with our ophthalmologists to assess:

• Eye alignment at distance and near

• Eye movements and muscle function

• The direction and amount of misalignment

• Double vision in different gaze positions

• Binocular vision and depth perception

• Abnormal head positioning

• Previous strabismus surgery or treatment

• Whether prism glasses may improve symptoms

These measurements help our physicians determine the cause of the misalignment and develop an individualized treatment plan.

Depending on the findings, additional medical evaluation or diagnostic testing may be recommended.

Treatment Options for Adult Strabismus and Diplopia

Prism Glasses

Prism lenses change the direction of light entering the eyes, helping the brain combine images more comfortably.

For some adults with double vision, prisms can provide significant relief without surgery.

Prisms may be incorporated into prescription glasses or applied temporarily using a thin Fresnel prism.

However, prisms do not correct the underlying eye misalignment and may not be effective for larger or more complex deviations.

Observation and Medical Management

Some forms of adult strabismus, particularly those associated with recent nerve palsies or certain medical conditions, may improve over time.

In these situations, monitoring or treatment of the underlying medical condition may be recommended before considering surgery.

Temporary prisms or other measures may help manage symptoms during this period.

Strabismus Surgery

For adults with significant or persistent eye misalignment, strabismus surgery may be recommended to improve the position of the eyes.

The procedure involves adjusting one or more of the muscles responsible for eye movement. Surgery may be performed on one or both eyes, depending on the type and amount of misalignment.

Potential benefits include:

• Improved eye alignment

• Reduced or eliminated double vision

• Improved binocular visual function in selected patients

• Reduced abnormal head positioning

• Greater visual comfort

• Improved quality of life and confidence

Although many patients experience meaningful improvements, results vary, and some individuals may require additional treatment or surgery.

Is Adult Strabismus Surgery Cosmetic?

No. Adult strabismus surgery can provide important functional benefits and should not automatically be considered cosmetic.

Eye misalignment may interfere with binocular vision, cause double vision, contribute to abnormal head positioning, and affect everyday activities.

Even adults who do not experience double vision may benefit from improved eye alignment and quality of life.

The potential benefits extend beyond appearance, although the emotional and social impact of correcting longstanding eye misalignment can also be significant.

Can Adults Have Strabismus Surgery if They Had Surgery as Children?

Yes. Some adults experience persistent or recurrent eye misalignment after childhood strabismus surgery.

Repeat surgery can be more complex because the eye muscles may have been repositioned previously or scar tissue may be present.

Our fellowship-trained pediatric ophthalmologists have specialized training in evaluating complex eye alignment disorders, including patients with previous strabismus surgery.

Why See a Pediatric Ophthalmologist for Adult Strabismus?

Although the name may be surprising, pediatric ophthalmologists are among the specialists with advanced training in strabismus and eye muscle surgery.

During fellowship training, pediatric ophthalmologists develop specialized expertise in eye alignment, binocular vision, and the medical and surgical treatment of strabismus in patients of different ages.

At Children's Eye Care, adult strabismus is an important part of our practice.

Our physicians treat adults with longstanding childhood strabismus, newly developed eye misalignment, double vision, and complex eye movement disorders.

The Importance of Certified Orthoptists

One of the distinguishing strengths of Children's Eye Care is our team of certified orthoptists.

Orthoptists specialize in evaluating eye alignment, eye movements, binocular vision, and double vision.

They perform detailed measurements, assess prism correction, and work closely with our physicians in developing and monitoring treatment plans.

This collaborative approach is especially valuable for patients with complex strabismus, diplopia, or previous eye muscle surgery.

The Emotional Impact of Adult Strabismus Treatment

For adults who have lived with eye misalignment for many years, seeking treatment can be a deeply personal decision.

Some patients have experienced difficulty making eye contact, self-consciousness about their appearance, or frustration after being told that nothing could be done.

Research has documented the effects strabismus can have on social interactions, emotional well-being, and quality of life.

While every patient's experience is different, successful treatment can have a meaningful impact beyond the physical alignment of the eyes.

At Children's Eye Care, we believe adults deserve to understand their treatment options, regardless of how long they have lived with strabismus.

Not a “vanity thing”

Children’s Eye Care’s orthoptist Mary DeYoung-Smith, CO, COMT can recall seeing many patients with adult strabismus who have hesitated to pursue corrective treatment viewing surgery as cosmetic in nature.

“That couldn’t be further from the truth,” she says. “Cosmetic is when you’re enhancing something that’s already normal. Your eye drifting outward is not normal.”

And to referral sources who consider strabismus correction cosmetic, Children’s Eye Care of Michigan’s doctors point to the visual, emotional, and social benefits documented to scholarly publications.  Every insurance carrier recognizes these benefits and covers the procedure.

“To insurance companies, this is never considered elective surgery,” Dr. Elena M. Gianfermi notes.

The ophthalmologists and orthoptists of Children’s Eye Care of Michigan never fail to be moved when a patient who has dealt with strabismus for years looks into the mirror for the first time and sees two straight eyes looking back.

“It’s hugely emotional,” Dr. Rajesh C. Rao says. “Very quickly they become more confident in the way they interact with people. They truly feel better about themselves.”

To learn more

For more information about adult strabismus correction in Michigan, call us at 866-338-3937 to schedule an appointment in our Clinton Township, Dearborn or West Bloomfield office.

Children’s Eye Care provides this information for general educational purposes only. It should not be construed as personal medical advice. Information published on this website is not intended to replace, supplant, or augment a consultation with an eye care professional. Children’s Eye Care disclaims any and all liability for injury or other damages that could result from use of the information obtained from this site.