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Adult Strabismus

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Adult Strabismus

What is adult strabismus? Strabismus is the medical term relating to a misalignment of the eyes and may develop at any time during an individual’s lifetime. When strabismus occurs in an adult for the first time, it produces a double vision or diplopia.


Causes of Strabismus in Adulthood

The most common causes of strabismus in adults are:

  1. Re-occurrence of ocular misalignment in an adult who had strabismus in childhood. Despite adequate treatment for strabismus in childhood, strabismus may recur later in life. This is usually caused by the inability to use both eyes together (binocular vision).
  2. Poor vision in one eye. People who have one eye that doesn’t see well, even when corrected with appropriate glasses, frequently develop strabismus of the poorly seeing eye; in most cases, the eye will deviate outward.
  3. Problems affecting the brain, such as stroke, tumor, or head trauma, may injure nerves that control the normal movement of one or more eye muscles, causing strabismus. Double vision in older adults is most often caused by high blood pressure or diabetes.

Treatment of Strabismus in Adults

Treatment of strabismus in adults depends on the cause and size of the strabismus. Small deviations that cause double vision may be treated successfully with prism glasses. These glasses do not cure the problem but instead compensate for it by correcting the direction and focusing the light rays that enter the eye, thereby eliminating the double vision. Only small angle deviations are treated with prisms, as large amounts of prism distort and blur vision, and may be very thick and heavy.

Most strabismus caused by microvascular disease resolve within several months. Therefore, the treatment for this type of strabismus is “tincture of time”. Patching of one eye, the use of prism glasses, or injection of BOTOX (botulinum toxin) to an eye muscle may alleviate the bothersome double vision until nature and time have corrected the problem.

Patients with longstanding strabismus, poor vision in one eye that has led to the development of strabismus, or ocular misalignment that results from head trauma or tumor may require surgical correction on the eye muscles of one or both eyes to achieve functional and restorative benefits.


Adult strabismus is very common and may develop for many reasons. Most adults are helped through a variety of treatment modalities, depending on the etiology and magnitude of the deviation. Sudden onset of double vision, without a history of head trauma, is an emergency, indicating a need for swift medical attention.

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