Strabismus Surgery: What You Need to Know
Pros & cons
How much it costs
The best age to get it
How the procedure works
Whether it's painful
How long recovery takes
The success rate
Fast facts
Strabismus surgery (sometimes called crossed eye surgery) corrects the muscles responsible for eye misalignment by detaching and reattaching them to the outside of the eye, in a more optimal position.
Strabismus can be a constant or intermittent eye condition. It can affect one eye or both, causing them to veer inward (esotropia), outward (exotropia), up, or down, which can appear as a lazy eye (amblyopia).
Each eye has six outer muscles controlling its movement. Strabismus occurs when one or more of these eye muscles is too strong or weak, upsetting the balance required for proper eye coordination.
With surgical intervention, the goal is to achieve binocular vision, with the two eyes working together.
“When the muscles that move your eyeballs are not in alignment, it causes double vision and, if left untreated, can cause decreased vision in one or both eyes,” says Dallas facial plastic surgeon Dr. John Standefer Jr. “This issue is best treated by a specialist in eye alignment surgery.”
Pros
- You’ll have improved vision, no double vision (a.k.a. diplopia), and better depth perception.
- With both eyes pointing the same direction, your overall appearance will improve, which can be a confidence boost.
Cons
- Minor risks include bleeding under the conjunctiva; abrasion of the cornea; or inflammation, such as pink eye.
- Rarely, loss of vision in the eye can happen.
- About 20% of patients need corrective surgery a few months after their procedure.
- Surgery may need to be repeated in the future, to maintain your results
- Average Cost:
- $5,050
- Range:
- $4,000 - $9,000
The average cost of strabismus surgery is $6,700, but reviewers on RealSelf report that they've paid anywhere from $4,000 to $9,000.
Most insurance companies cover at least a portion of this procedure because it corrects a medical condition that causes functional disability.
Your out-of-pocket expenses will depend on your surgeon's level of expertise, where the surgery is performed, the type of anesthesia you have, and how much is covered by insurance.
Strabismus treatment before the age of two will give the best results, particularly if you see an experienced pediatric ophthalmology specialist.
While it was once thought to only be a cosmetic fix for adult strabismus patients, the American Academy of Ophthalmology now says that eye muscle surgery can also correct strabismus and improve alignment of the eyes in adult patients.
Adults also have nonsurgical treatment options, such as eye exercises and specialized glasses.
Strabismus surgery is usually performed in about one hour, under general anesthesia, although some adults prefer to be awake, with local anesthesia and sedation.
During the surgical procedure, n incision is made in the clear membrane (called the conjunctiva) lining the white part of the eye. The rectus muscles are separated and moved to new positions to adjust their tension on the eye—creating more or less pull, whichever is necessary to straighten the eye position.
In what’s known as a “recession procedure,” the health care provider aims to relax a muscle with too much torque by moving it further back on the eye.
If a weak muscle is the cause of strabismus, the surgeon will vary their technique, adjusting the force of its opposing muscle to bring about balance.
Once the muscles are repositioned, they're attached with dissolvable sutures. Many ophthalmologists now use adjustable sutures, which allow them to fine-tune eye positioning after surgery.
With adjustable suture surgery (think: tiny slipknot), the surgeon—using only anesthetic eye drops in the recovery room—can tug the suture to subtly and painlessly shift the extraocular muscles until the eye is perfectly positioned.
The surgery itself isn't painful, thanks to anesthesia. You can choose between general anesthesia or a combination of local anesthesia and sedation, if you prefer to be awake.
Either way, it'll keep you comfortable during the procedure and your initial recovery.
Most eye doctors recommend taking a week off work following the surgical treatment. Pain medication is rarely needed after strabismus surgery, but antibiotic-steroid drops should be used for about a week, to prevent infection and encourage healing.
You may experience discomfort, swelling and blurred vision in the treated eye for at least a few days.
You can resume most normal activities right away, but don’t drive during this time, and avoid getting water into your eyes during the first week of recovery.
Also avoid wearing contact lenses for at least two weeks.
Once the sutures dissolve (within a week or so), irritation should subside. Redness may persist for a couple of months, but it will gradually fade.
The success rate is approximately 80%, with about 20% of patients requiring follow-up surgery six months after the primary procedure.
Since strabismus surgery addresses only the muscles of the operated eye, not the way in which the brain communicates with the muscles to control their function, the eyes can once again fall out of alignment over the course of months or years. In that case, you may need reoperation.
Updated June 13, 2023