Strabismus Surgery

10 sources cited
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What is Strabismus Surgery?

Strabismus surgery or eye muscle surgery is a corrective treatment for eye misalignment (strabismus). Studies indicate that strabismus affects about 4% of the U.S. population.1 

Due to muscle dysfunction, people with strabismus find it difficult to control their eyes. As a result, one eye may look directly at an object while the other may look in a different direction.

Risk factors include:2

  • Childhood history of strabismus
  • Head trauma
  • Nerve diseases such as multiple sclerosis
  • Previous stroke

Strabismus surgery entails loosening or tightening the eye muscles to restore proper alignment and muscle movement.3

What Eye Issues Can Strabismus Surgery Treat?

Strabismus surgery treats several types of eye issues, based on the direction of misalignment. They include:

  • Esotropia (crossed eyes). When the eye turns inwards, towards the nose.
  • Exotropia (walleye). When the eye turns outwards away from the nose.
  • Hypertropia. When one eye turns upwards.
  • Hypotropia. When one eye turns downwards.
  • Cyclotropia ( rotational strabismus). When one eye rotates outwards or inwards around its visual axis.

If left untreated, strabismus may reduce vision in one eye (amblyopia or lazy eye). It may also result in low self-esteem due to appearance issues.

Early strabismus diagnosis can prevent serious conditions such as brain tumors. A brain tumor can cause misalignment by interfering with the afferent and efferent visual pathways.4

Who is a Candidate for Strabismus Surgery?

Strabismus surgery is ideal for both children and adults with eye misalignment issues. You may qualify for strabismus surgery if you:

  • Have crossed eyes
  • Experience blurry or double vision
  • Experience changes in depth perception
  • Have difficulty reading
  • Squint your eyes
  • Tilt your head to see clearly

You will not qualify for strabismus surgery if you:

  • Have muscle or nerve disorders such as muscular dystrophy, myasthenia gravis, or spastic cerebral palsy
  • Have unrealistic expectations (e.g., if you expect not to wear your eyeglasses after surgery)
  • Have underlying health conditions that can interfere with surgery or healing
  • Take certain medications such as blood thinners that can cause excess bleeding during surgery

If you don't qualify for surgery, your doctor may recommend alternative options such as:

  • Eyeglasses or contacts. For people with refractive errors.
  • Patching (occlusion). Treats amblyopia (lazy eye) alongside strabismus. 
  • Prism lenses. Special lenses that regulate the amount of light entering the eyes.
  • Botulinum toxin injection. The botulinum toxin is known to weaken overactive muscles for extended periods. This makes it effective in treating early overcorrection after strabismus surgery.
  • Monocular occlusion or fogging. Treats intractable diplopia or candidates who don't qualify for surgery.
  • Eye exercises. Useful in mild strabismus cases.

Strabismus Surgery Procedure: What to Expect

Below is what to expect before, during, and after strabismus surgery:

Before Surgery

Before surgery, your eye doctor will conduct tests to determine your general health, eye health, and the best type of surgery to perform. If you qualify for the procedure, they will schedule you for surgery.

Your doctor might instruct you to stop using certain medications such as blood thinners and nonsteroidal anti-inflammatory products (NSAIDs) at least one week before surgery. 

Ask a friend or family member to drive you to your surgery, as your ability to drive may be affected for several days. Also, avoid eating or drinking several hours before surgery.5

During Surgery

Strabismus surgery is an outpatient procedure performed under general or local anesthesia, depending on the extent of the condition. 

After sedation, the surgeon will hold your eyes open using an eyelid holder. Then they will make an incision in the conjunctiva to access and isolate the eye muscles. The conjunctiva is the eye's mucous membrane that covers the sclera (white of the eye).

The surgeon will either perform a muscle recession, a muscle resection procedure, or an adjustable suture procedure.

  • Muscle recession. This procedure addresses tight eye muscles that cause the eye to pull in one direction. It involves detaching the muscle and reattaching it further back in the eye. Doing this weakens the muscles, resulting in improved alignment.
  • Muscle resection. This procedure addresses weak eye muscles. It involves detaching the eye muscle from its original position and shortening it before reattaching it. This strengthens the muscles and enables better alignment.
  • Adjustable suture procedure. This procedure happens during muscle recession or resection. Adjustable sutures are adjustable knots that enable the surgeon to easily change the muscle attachment position if your eyes don't align well after the initial surgery.6

When the muscle is reattached to the eyewall, the surgeon uses a permanent knot instead of an adjustable suture. They may also use an adjustable suture technique that uses either a temporary bow knot or a slip knot.  

The surgeon can make adjustments following surgery. They typically perform these adjustments under local anesthesia. The adjustable suture procedure is typically performed on adults.

After Surgery (Recovery)

After strabismus surgery, your sclera (white of the eye) may appear red. A return to normal can take weeks to months after surgery. During early recovery, you're likely to experience some pain and discomfort, which should clear up with time.

It's also advisable to see your doctor for follow-up care. During follow-up visits, your surgeon will evaluate the healing process and make any adjustments if necessary.

If your surgeon uses an adjustable suture, they might provide a protective patch to wear. They might also prescribe medications such as antibiotic eye drops or ointments to ease any discomfort and prevent infections.

Most people can resume normal activities after about 2 weeks. Always consult your eye doctor before resuming strenuous or risky activities such as contact sports or swimming.

If strabismus is caught early enough in children, it can restore vision and depth perception. It can also prevent vision loss.7

What are the Risks of Strabismus Surgery?

Common side effects of strabismus surgery include:

  • Sore, gritty, or red eyes
  • Double vision (lasts a few days to a few weeks)
  • Eyestrain
  • Headache
  • Blurry vision 

Some possible complications of strabismus eye surgery include:

  • Poor eye alignment
  • Vision changes
  • Diplopia (double vision)
  • Scarring
  • Damaged sclera
  • Post-operative infections
  • Allergic reaction
  • Lost muscle8
  • Subconjunctival abscess

You can minimize complications if your doctor thoroughly examines you before the surgery. You should also adhere to post-operative care practices to further reduce the risk. 

Call your doctor if you notice the following after surgery:

  • Obvious signs of bleeding
  • Fluctuating vision
  • Intense eye pain
  • Unbearable sensitivity to light
  • Signs of infections such asasf pus

Strabismus Surgery Outlook and Success Rates

Many people are misinformed about the risks and benefits of strabismus surgery. In most cases, the procedure is safe and effective.

About 80% of adult patients report satisfactory results after one surgical procedure.9 In addition, there is a low risk of serious complications. 

Note: Strabismus may not correct vision. In many cases, success is defined by an improvement in appearance. However, most adults realize some improvement in binocular function after eye muscle surgery.10 Some people may regain stereopsis (depth perception).

People who do not have correct alignment after the first strabismus surgery might benefit from a second surgery. This usually happens after a few months to a few years after the outcomes from the first surgery have stabilized.


Strabismus surgery, or eye muscle surgery, corrects eye misalignment (strabismus). It involves loosening or tightening the eye muscles to restore proper alignment and muscle movement.

Strabismus surgery treats several types of eye issues such as:

  • Esotropia (crossed eyes)
  • Exotropia (walleye)
  • Hypertropia
  • Hypotropia
  • Cyclotropia (rotational strabismus)

The surgery occurs in an outpatient setting. It involves surgical detachment and reattachment of eye muscles that cause eye misalignment because they are either too weak or too tight.

Strabismus surgery is a safe and effective eye surgery, with about 80% of adult patients reporting positive results after one procedure.9 Strabismus surgery also has a low risk of serious complications.

People who do not have correct alignment after the first strabismus surgery might benefit from a second surgery a few months to a few years later.

10 Cited Research Articles
  1. Suh, D. et al.,“Strabismus Surgery, Horizontal,” American Academy of Ophthalmology, 30 Mar. 2022
  2. Strabismus,”  The University of Pennsylvania
  3. Strabismus (crossed eyes),” American Optometric Association (AOA)
  4. Peragallo J.,“Effects of Brain Tumors on Vision in Children,” National Center for Biotechnology Information (NCBI), Fall 2018
  5. Nonsteroidal Anti-inflammatory Drugs (NSAIDs),” US Food and Drug Administration (FDA) 31 Dec. 2020
  6. Adjustable Sutures in Strabismus Surgery,” American Association for Pediatric Ophthalmology & Strabismus, Apr. 2020
  7. Strabismus (Crossed Eyes),” Cleveland Clinic, 22 Jan. 2019
  8. Suh D. et al.,“Strabismus Surgery Complications,” American Academy of Ophthalmology, 10 Mar. 2022
  9. Kushner  B.,“The efficacy of strabismus surgery in adults: a review for primary care physicians,”  National Center for Biotechnology Information (NCBI), 27 Jan. 2011
  10. Mets M.,  Beauchamp C., and Haldi  B.,“Binocularity Following Surgical Correction Of Strabismus In Adults,” National Center for Biotechnology Information (NCBI), 2003
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