Adult Strabismus: Recognizing and Treating Crossed Eyes Early

When we think of “crossed eyes” or strabismus, we often picture a young child. However, this condition is not confined to infancy. A significant number of adults live with strabismus, a visual disorder where the eyes do not properly align with each other when looking at an object. For many, it’s a condition they’ve had since childhood, but for others, it can develop later in life. The impact goes beyond vision; it can affect social interactions, self-esteem, and overall quality of life. The crucial message that often gets lost is that it is never too late to seek treatment. Recognizing the signs and understanding the modern treatment options available is the first step toward reclaiming clear, comfortable, and confident vision.

What Exactly is Adult Strabismus?

Strabismus is a condition characterized by a misalignment of the eyes. One eye may turn in (esotropia), out (exotropia), up (hypertropia), or down (hypotropia) while the other eye focuses correctly. This misalignment can be constant or intermittent, appearing only when a person is tired, stressed, or focusing on a near object.

In childhood, the brain is remarkably adaptable. To avoid double vision (diplopia), a child’s brain may learn to ignore the image from the misaligned eye, leading to a condition called amblyopia or “lazy eye.” In adults, however, the brain’s visual pathways are fully developed. This means when strabismus occurs or becomes apparent in adulthood, the brain is unable to suppress the second image, often resulting in persistent double vision and significant visual confusion.

What Causes Strabismus to Appear in Adulthood?

Adult-onset strabismus can arise from several different sources. Understanding the root cause is essential for determining the correct treatment path.

Decompensated Childhood Strabismus

Many adults with strabismus have had it since childhood. Sometimes, the misalignment was subtle or well-controlled for years but “decompensates” later in life. Factors like stress, illness, fatigue, or the natural aging process can overwhelm the brain’s ability to keep the eyes aligned, making a once-minor issue much more noticeable and problematic.

Nerve Palsy

The eyes are moved by six muscles, each controlled by specific cranial nerves. Damage or paralysis (palsy) of these nerves can cause the eye to drift. Common causes of nerve palsy include:

Diabetes: High blood sugar can damage small blood vessels supplying the nerves.

High Blood Pressure: Similar to diabetes, hypertension can affect nerve blood flow.

Head Trauma: An injury can damage or stretch the delicate nerves.

Stroke: A stroke can interrupt the brain’s signals to the eye muscles.

Physical Disorders

Certain physical conditions can directly affect the eye muscles themselves.

Thyroid Eye Disease (Graves’ Disease): This autoimmune disorder causes inflammation and scarring of the eye muscles, leading to restriction and misalignment, often with a characteristic staring appearance.

Myasthenia Gravis: This neuromuscular disease causes muscle weakness that can affect the eyelids and eye movements, leading to variable and fatigable strabismus.

Other Contributing Factors

Other potential causes include tumors, aneurysms, or even as a complication from eye surgery, such as cataract surgery.

The Far-Reaching Consequences of Untreated Strabismus

The effects of adult strabismus extend far beyond the physical misalignment. The most immediate and distressing symptom is often double vision (diplopia). This can make everyday tasks like driving, reading, and walking down stairs dangerous and difficult.

Perhaps less obvious but equally damaging are the psychosocial effects. In a society where eye contact is a fundamental part of communication, having a misaligned eye can lead to:

Significant social anxiety and self-consciousness

Difficulty with interpersonal relationships and job interviews

Perceptions by others that the individual is not paying attention or is “shifty”

A negative impact on overall mental health and self-esteem

Furthermore, the constant effort to align the eyes or cope with double vision can lead to asthenopia (eye strain), headaches, and a general feeling of visual discomfort.

Modern Treatment Options: There Is Hope

The good news is that adult strabismus is highly treatable. The goal of treatment is to restore binocular vision (the ability to use both eyes together), eliminate double vision, and, of course, improve cosmetic appearance. A comprehensive evaluation by an ophthalmologist, specifically a strabismus specialist, is the first step.

Non-Surgical Interventions

For some adults, surgery is not the first or only option.

Prism Lenses: These are special glasses that bend light entering the eye, effectively shifting the image to align with the misaligned eye. This can successfully eliminate double vision for many patients. Prisms can be ground into the lens or applied as a temporary film.

Vision Therapy (Orthoptics): While more common in children, certain types of strabismus in adults can be improved with targeted eye exercises. These exercises help improve eye coordination and control, especially in cases of convergence insufficiency (difficulty turning the eyes inward to read).

Botox Injections: In some specific cases, an injection of botulinum toxin (Botox) into an overactive eye muscle can temporarily weaken it, allowing the opposing muscle to tighten and pull the eye into better alignment. This can be a standalone treatment or used in conjunction with surgery.

Strabismus Surgery

Surgery is a common and very effective treatment for correcting eye misalignment. The procedure involves adjusting the position or length of the eye muscles on one or both eyes to change the eye’s position. Contrary to common fears, this surgery is typically performed as an outpatient procedure, meaning you go home the same day.

Modern strabismus surgery is highly refined. Surgeons can make precise calculations to achieve the desired alignment. While the primary goal is functional, the cosmetic improvement is dramatic and can be life-changing. Recovery is relatively quick, with most people returning to normal activities within a few days.

Why Early Intervention Matters, Even for Adults

The term “early intervention” in the context of adult strabismus doesn’t refer to the age of the patient, but rather to the timing of treatment after the problem is recognized. Delaying treatment can allow the brain to develop adaptive mechanisms, like a abnormal head posture (tilting or turning the head), which can lead to neck and back pain. Furthermore, living with the functional and social burdens of strabismus is unnecessary when effective solutions exist. Seeking an evaluation at the first sign of symptoms—whether it’s double vision, noticeable eye turning, or eye strain—is the key to preventing long-term complications and improving your quality of life.

If you or an adult you know is experiencing symptoms of strabismus, do not dismiss them as untreatable or merely a cosmetic concern. Schedule a comprehensive eye exam. A clear, single, and confident world of vision is not just a childhood privilege—it’s a possibility at any age.