Strabismus surgery, also referred to as eye muscle surgery or extraocular muscle surgery, is a specialized procedure designed to correct strabismus—a condition in which the eyes are misaligned and cannot focus on the same point simultaneously. Commonly known as “crossed eyes,” “wandering eyes,” or “lazy eye,” strabismus affects roughly 5% of the population.

This misalignment is caused by imbalances in the extraocular muscles, leading to one eye turning inward (esotropia), outward (exotropia), upward (hypertropia), or downward (hypotropia). Strabismus surgery adjusts muscle position or length—through recession, resection, plication, or transposition—to restore eye alignment .

While often performed during childhood to optimize visual development and binocular function, adults also benefit from the procedure, especially to improve quality of life and reduce double vision . This guide provides a comprehensive overview of symptoms, causes, diagnosis, treatment, and recovery of strabismus surgery.

Symptoms of Strabismus

Recognizing signs of strabismus early is essential for effective treatment. Common symptoms of strabismus include :
Eyes that do not move together or point in different directions (inward, outward, vertical deviations)

Head tilting or squinting to focus
Double vision (diplopia), especially in adults
Blurred vision or poor depth perception
Frequent eye rubbing, blinking, or light sensitivity (photophobia)
Amblyopia (“lazy eye”) due to suppression of the deviating eye in children

Children may further exhibit behavioral signs like turning the head or covering one eye. Adults may notice persistent eyestrain or drifting vision. Untreated strabismus in early life can lead to permanent vision loss (amblyopia) , so early detection matters.

Causes of Strabismus

Understanding the causes of strabismus helps guide therapy. Common contributors include :

Refractive errors: farsightedness commonly causes inward turning (esotropia) due to excessive focusing efforts; nearsightedness or astigmatism may lead to outward turning (exotropia).
Muscle abnormalities: imbalance or structural issues in the extraocular muscles lead to misalignment.
Neurological conditions: brain trauma, stroke, cranial nerve palsies, cerebral palsy or tumors affecting ocular motor control.
Genetics or syndromic conditions: Certain inherited disorders (Noonan, Down syndrome) increase risk .
Eye injuries or diseases: injury, infection, thyroid eye disease, cataracts or retinal disorders may alter muscle function.

In infants, some amount of eye misalignment is normal up to 3–4 months but persistent misalignment beyond this suggests strabismus .

Diagnosis of Strabismus

Accurate diagnosis of strabismus is critical before recommending surgery. Eye specialists—ophthalmologists and orthoptists—use several tests to evaluate alignment and ocular health :

Cover/uncover test: reveals manifest (heterotropia) or latent (phoria) misalignments.
Corneal light reflex test (Hirschberg): assesses eye direction by reflecting light off the cornea.
Prism testing: measures the angle of deviation in prism diopters.
Visual acuity and refraction exams to determine glasses needs.
Orthoptic evaluation: assesses binocular function and ocular motility.
Retinal and neurological evaluation to rule out underlying pathology.

Once alignment and vision are assessed, a customized treatment plan—surgical and/or non-surgical—is developed.

Treatment Options Before Surgery

Non-surgical treatment of strabismus may include :

Corrective glasses: especially for esotropia due to hyperopia.
Prism lenses: to reduce double vision.
Vision therapy: eye exercises to strengthen coordination.
Occlusion therapy (patching): encourages weaker eye use in children.
Botulinum toxin injections (Botox): temporary muscle weakening for alignment adjustment .

If these fail—or in moderate to severe cases—strabismus surgery is considered to realign eyes permanently.

Strabismus Surgery: Procedure & Types

Strabismus surgery is typically an outpatient procedure performed under general anesthesia, especially in children; some adults may receive local anesthesia with sedation . The surgeon accesses the muscles through small incisions in the conjunctiva and adjusts them via:

Recession: moving a muscle back to weaken its effect.
Resection/Plication: shortening or folding muscles to strengthen.
Transposition: repositioning muscles for optimal movement alignment.
Adjustable sutures: enable fine-tuning postoperatively with patient awake .
Minimally invasive strabismus surgery (MISS): smaller “keyhole” incisions for less swelling and faster recovery .

Procedure time ranges from 45 minutes to 90 minutes depending on complexity .

Recovery After Surgery

Recovering from strabismus surgery generally involves mild discomfort, redness, and watering eyes . Typical recovery steps include:

Post-op observation: monitored in recovery for vital signs; a driver is needed home.
Mild pain relief: NSAIDs or acetaminophen; antibiotic/lubricating eye drops prescribed .
Activity restrictions: avoid swimming and strenuous activity for 1–2 weeks .

Healing timeline:

Redness & light bleeding for a week+ (normal pink tears possible) .
Vision may be blurry and double vision may persist temporarily .
Days 3–5: adults can often return to work, children to school .
Final alignment stabilizes over 6–8 weeks .

Follow-up visits are essential to monitor healing and decide if additional surgery is needed to correct residual deviation .

Why Strabismus Surgery Is Worth It

Benefits of strabismus surgery include :
Restored cosmetic appearance and balanced eye alignment
Improved depth perception, eye coordination, and binocular vision
Reduced or eliminated double vision
Boosted self-esteem, particularly in children

Though risks are low, they include infection (1 in 1,100–1,900 chance), bleeding, over- or under‑correction, or rare muscle slippage. Opting for experienced ophthalmologists minimizes these.

Conclusion

Strabismus surgery is a safe, effective way to correct misaligned eyes and restore visual function. By adjusting the extraocular muscles—via recession, resection, transposition, or modern minimally invasive techniques—patients can enjoy improved alignment, depth perception, reduced diplopia, and enhanced confidence.

From childhood through adulthood, early diagnosis (via cover tests, prism measurements, orthoptic evaluations) and timely intervention yield the best outcomes. Non‑surgical treatments like glasses, patching, vision therapy, or Botox have a role, but surgery remains the most reliable solution when these aren’t sufficient.

If you or a loved one experience symptoms of strabismus, seek an ophthalmology evaluation promptly. Discuss the benefits, risks, and recovery expectations—then take the first step toward clearer, happier vision.