Adult Strabismus

While strabismus - commonly known as misalignment or crossed eyes - frequently develops in childhood, many adults are faced with this ocular problem. All members of the Division of Neuro-ophthalmology at the University of Pennsylvania are trained to treat adult strabismus-related problems. In addition, Dr. Madhura Tamhankar is specially trained in strabismus surgery. They will work with patients to preserve vision, align the eyes, and restore binocular (two-eyed) vision.

What is Strabismus?

Strabismus is an ocular condition that occurs when the eyes are misaligned and point in different directions from each other. One eye might look forward while the other turns inward, outward, upward or downward.



Patient 1. Esotropia (eyes turned in)

Patient 2. Exotropia (eyes turned out)

Also, each eye may alternate between looking straight ahead and turning. As a result, the eyes don't work together. Each sees a different image, rather than the normal single fused image.

Strabismus can occur at anytime-infancy, early childhood, or adulthood. When it happens in children, double vision rarely results because the brain is able to process the image from one eye while suppressing the vision in the other. However, when strabismus presents in adults, double vision may occur. In some adults, a childhood misalignment may worsen and double vision may or may not be present.

Causes of Adult Strabismus

The following are the most common causes of strabismus in adults:
- childhood history of strabismus (with or without previous surgery)
- orbital disease such as thyroid eye disease
- previous stroke or previous neurosurgical procedure
- head trauma
- diseases that affect the nerves, such as multiple sclerosis
- poor vision in one eye
- vascular insults to a nerve that controls the movement of one or more eye muscles.

What are Symptoms of Adult Strabismus?

The main symptom is a turned eye, although significant misalignment may be present without a visible difference in the position of the two eyes. Adults frequently experience double vision. Other patients may experience symptoms that may seem more vague including trouble focusing, eye strain, images jumping, difficulty tracking on a page, or loss of peripheral vision.


The primary goal is to align the eyes and restore binocular vision. Only after a complete eye examination can the eye care specialist suggest the appropriate optical, medical or surgical therapy. Depending on the cause of the strabismus, treatment can involve the following:

Many acquired conditions improve spontaneously with time. All patients with newly acquired problems should be observed for changes or improvement. In the interim a patch or frosted lens can be used to occlude the vision in one eye and prevent double vision.

At times, patients benefit from eye exercises.

In patients with small angle deviations, prisms (eye glass lenses which shift the image from one eye toward the other) can be either temporary (paste on) or actually ground into the patient's eye glass lens.

Surgical procedures on the eye muscles can be used to realign the eyes in most patients with strabismus for almost any reason.



Patient 1. Esotropia after surgical repair (eyes formerly turned in).

Patient 2. Exotropia after surgical repair
(eyes formerly turned out).


Dr. Madhura Tamhankar maintains an active surgical ophthalmic practice, with a special interest in strabismus.

A small incision is made into the tissue covering the eye to reach the eye muscles. Certain muscles are repositioned during surgery, depending on the direction the eye is turning. Surgery may be needed on one or both eyes. The surgeon may choose to use an "adjustable suture". In this procedure, the operation is done so as to place one or more muscles on a "pulley".

The pulleys are then adjusted the next day with the patient awake thereby increasing the likelihood of successful alignment of the eyes. There is only minimal discomfort involved with this adjustment procedure.

People recover quickly from this procedure and are able to return to normal activities within a few days. In a few instances, additional surgery may be necessary to keep the eyes aligned.

Strabismus surgery is usually a safe and effective treatment. However, as with any surgery, strabismus surgery has certain risks including infection, bleeding, excessive scarring, and other rare complications that can lead to loss of vision.

How can I receive a strabismus evaluation?

To learn more about our services and specialists, or to make an appointment, please call PENNLine, 1-800-635-7780. Alternatively, for appointments with Dr.
Shindler, Tamhankar, or Ross at the Scheie Eye Institute call 215-662-8100, or with Dr. Avery, Hamedani, or Liu at the Hospital of the University of Pennsylvania or Dr. Hamedani at Pennsylvania Hospital call 215-662-3606.