Dr. Orwa Nasser MD MPH - Strabismus surgeries in adults

Strabismus surgeries in adults

Squint in adults is a condition of deviation and misalignment between the eyes in patients over the age of 18. In this case, the eyes do not look in the same direction, but each eye looks in a different direction. If one eye, or both eyes, look inward, this is called esotropia. If one eye, or both eyes, look outward, this is called exotropia. The misalignment between the eyes may be vertical, where one eye looks up or down, which is called hypertropia or hypotropia.

What causes strabismus in adults?
Squint may start during childhood or develop in adulthood. A common cause of strabismus is that a person may have had strabismus in childhood, then the strabismus returns or there is a residual strabismus from the past. Other common causes include corneal nerve palsy (most common in the fourth or sixth nerve. Common causes of this paralysis are stroke, diabetes, high blood pressure, accidents, etc.), thyroid disease, eye surgery, eye and head injuries, and other causes such as cerebral palsy, Down syndrome, hydrocephalus, or brain tumors.

What are the symptoms of strabismus in adults?
Strabismus in adults can cause double vision (diplopia), visual confusion, problems with depth perception, difficulty reading, and headaches.

How is strabismus diagnosed?
Patients often diagnose themselves if they have strabismus, as do close relatives and friends. To confirm this diagnosis, the patient can undergo an examination by an ophthalmologist who will assess the degree of strabismus and determine its causes.

What is the treatment for strabismus?
Treatment for strabismus in adults is very successful. Depending on the degree and cause of strabismus, surgical and non-surgical treatment can be provided. Non-surgical treatment includes prisms, eye patches, and Botox injections. In most cases, strabismus requires surgery. This is usually done under general or local anesthesia and intravenous sedation. For adults, the procedure can be performed using an adjustable suture technique that allows us to fine-tune the strabismus eye shortly after surgery, if necessary. Dr. Nasser will discuss the best option for you during your examination.

How does Dr. Nasser perform strabismus surgery?
Dr. Nasser performs the surgery under general anesthesia, where the patient is asleep, or under local anesthesia, where the patient is awake but does not feel pain during the procedure. In many cases, sedative medications are given to reduce your anxiety. You can go home after the procedure and do not need to stay in the hospital overnight. The procedure is performed on one or both eyes, depending on the type and degree of strabismus you have. 

During the procedure, the doctor exposes the eye muscles through a tissue deep under the eyelid, so that no scars will be visible after the surgery. He then exposes the eye muscles and repositions them in the eye. The incisions are closed with fine sutures placed inside the eye, but they are not visible and dissolve on their own after two weeks. If the operation is performed using the adjustable suture technique, precise adjustment of the eye can be made shortly after surgery. At the end of the operation, a clear shield is placed over the eyes, and you can go home with specific instructions and a follow-up the next day.