Can Crossed Eyes or Wandering Eyes be Fixed?

In a word, yes!

People with strabismus -- the medical term for eye misalignment -- whether they have an eye that turns in (esotropia) or wanders out (exotropia), or an eye that goes up (hypertropia), don't have to just "live with it." In almost all cases, they can be treated successfully. The most common treatment options are glasses and eye muscle surgery.

This child has esotropia.

This child has esotropia.

Patients frequently come to see me for strabismus and report having been told by prior physicians, sometimes even eye doctors, that "nothing could be done." I often hear comments after corrective surgery like, "If I had known this could have been fixed, I wouldn't have lived with it all these years!"

Strabismus often causes double vision, especially in adults, and people who haven't lived with double vision rarely grasp how unpleasant, frustrating, and debilitating this condition can be. Even when eye misalignment doesn't cause double vision, in our society, there is an unfortunate but real stigma associated with strabismus, and patients often suffer socially. Children and adults with strabismus are often, incorrectly and unfairly, perceived as less intelligent. Fortunately, as mentioned above, this doesn't need to be the case.

There is no "age limit" to strabismus surgery. This procedure is relatively quick, typically lasting about 40 minutes, and is performed under general anesthesia on an outpatient basis, with patients going home the same day.

Because eye misalignment is often associated with poor vision in childhood, and rarely with an underlying medical problem, if your child's eyes aren't straight, be sure to schedule a visit to see an eye doctor.

To learn more about health insurance coverage for eye muscle surgery, read this.

If you would like to learn about what you might expect in the recovery period after strabismus surgery, click here.

Finally, here is some additional information about reasons why you might consider having strabismus surgery.

Why do I get blind spots with migraine headaches?

I often meet with children in my clinic who report having temporary blind spots in their vision, that seem to grow in size. This can be a frightening experience! Children and their parents are often worried about a severe eye problem in this scenario, particularly if no one in the family has ever experienced similar symptoms.

Fortunately, the eye exam in this setting is almost always normal. How can this be, one might ask? It's because a very common cause of this symptom is migraine, which is a headache syndrome. The root of the problem originates in the brain, not in the eyes -- so the eye exam is normal. The visual symptoms that many people experience with migraine headaches are called "auras."

Migraine headaches are common in children and adolescents, and often follow a course something like this: the person notices a small smudge in their vision, which over the course of a few minutes, expands in size to cover most of their field of vision in both eyes. The edges of this blind spot are often shimmering zigzags, sort of like looking through a kaleidoscope. This aura slowly recedes, and a headache then follows. The headache is often severe, and may be associated with sensitivity to bright lights or loud noises, and the person may be nauseated. Roughly 30% of migraineurs will experience an aura before their headache; sometimes the aura may occur by itself, without a headache.

I recently met a very sharp young patient named Brooke who gave me permission to share her story. She was experiencing frequent blind spots in her vision, and she and her mother were understandably worried by them. I asked if her blind spot started small, like a smudge, and then gradually grew. She nodded. I asked if the edges were shimmering zigzags. She nodded again. I asked if the spot then went away slowly and if she got headaches around the same time. Her eyes got big, she smiled, and said, "You get me!"

To my delight, she then pulled out some drawings that she had made of the vision changes that she gets with her migraine headaches. As a frequent migraineur myself, I found them strikingly accurate. She kindly gave me permission to share them here, so that others could learn about them.

Brooke described how, with her migraine headaches, she would initially get a blind spot with a jagged edge, which a few minutes later would then fill in and be impossible to see through.

Brooke described how, with her migraine headaches, she would initially get a blind spot with a jagged edge, which a few minutes later would then fill in and be impossible to see through.

This is a great example of a jagged, colorful arc that develops at the edge of the expanding blind spot in someone with a migraine aura. It's known as a "scintillating scotoma," or a sparkly blind spot.

This is a great example of a jagged, colorful arc that develops at the edge of the expanding blind spot in someone with a migraine aura. It's known as a "scintillating scotoma," or a sparkly blind spot.

Interestingly, not all auras are visual; some patients experience sensory auras involving a pins-and-needles feeling in the arms or face, which may be followed by numbness.

Patients with visual symptoms followed by headache should consult with their primary doctor. If the primary doctor has concerns about the possibility of a visual problem, a referral to an eye doctor can be pursued.

When does my child need an eye exam?

Parents frequently wonder how often, or when, their children need eye exams. As discussed in this brief video, there are three scenarios in which you should schedule a formal eye exam for your child:

  1. Your child has a symptom or sign of a vision/eye problem, such as blurry vision, an eye that turns in or drifts out, a change in the appearance of the eye, etc.
  2. A physician or teacher is concerned about your child's vision. This is often due to difficulty with a routine vision screening examination.
  3. There is a family history of childhood eye problems.

If you're concerned about a possible eye problem for your son or daughter, schedule an appointment -- I'd be happy to meet you, discuss your concerns, and do a complete eye examination.

What's the recovery like after strabismus surgery?

Strabismus surgery, or eye muscle surgery to realign the eyes, is done on an outpatient basis, so patients are able to go home an hour or two after the surgery is done.

Because strabismus surgery is done under general anesthesia, patients will be fairly groggy afterward, and must have someone with them to drive them home.

There are a few things that are normal symptoms to have after surgery, including:

  • Red eyes, typically lasting a week or two
  • Eye pain, which is usually mild and improves within a few days
  • Blurry vision
  • Eye discharge, which may be yellow, red, or even light green sometimes!
  • Double vision, which is not unusual during the first few weeks of the healing process, especially for adults

Symptoms that are not expected, and should prompt a phone call, include:

  • Severe eye pain not responsive to ice packs or oral pain medication
  • Swelling of the eyelids that is so severe the patient can't open their eyes
  • Worsening redness
  • Vision that continues to get worse

Most patients do very well after strabismus surgery, and need only a few days off from school or work. Plan on seeing me in the office a week after your surgery to check to make sure your eyes are healing normally, and then again six weeks later to assess the outcome of the surgery.

How do you measure strabismus (eye misalignment)?

Strabismus can affect both children and adults, and occurs when the eyes are not aligned. As you may know, the misalignment can be very small, very large, or anywhere in between. By using prisms -- just like the prisms you learned about in science class -- we can measure the amount of misalignment, which helps to determine what is causing the strabismus, whether it's getting better over time, and how best to treat it.

Prisms come in different sizes, allowing us to measure eye misalignment.

Prisms come in different sizes, allowing us to measure eye misalignment.

Using prisms to measure any strabismus detected on the eye exam is a critical component of the eye exam. Although the prisms are held near the eyes, they don't hurt in any way, and it's possible to get useful measurements with prisms for the majority of patients. As your child grows, our ability to measure their eye misalignment will likely get even better, too.

 

When is strabismus surgery needed?

For patients both young and old with eye misalignment, or strabismus, surgery can often be performed.

Some reasons to perform strabismus surgery include the following:

This child has a dissociated vertical deviation (DVD), a type of strabismus in which one eye will periodically drift upward, while the other eye stays put. Surgery can be curative.

This child has a dissociated vertical deviation (DVD), a type of strabismus in which one eye will periodically drift upward, while the other eye stays put. Surgery can be curative.

  1. To help the eyes work together and promote the development of good binocular vision, or depth perception. This is most important for young children, during the critical period of visual development that occurs in the first few years of life.
  2. To eliminate double vision. This is usually more of a concern for adults, as children with strabismus typically ignore the second image and don't have double vision.
  3. To minimize any abnormal head turn or tilt that a patient might prefer, either consciously or subconsciously, to try to minimize their strabismus. These abnormal head postures, if present chronically, can become physically and socially disabling.
  4. To improve the ability to interact with others. There is an unfair stigma that often exists in society with regard to people with eye misalignment. I love helping people get their eyes straight, not only because it helps their vision, but also because it helps them gain confidence in their social interactions.

What to expect during your child's eye exam

This short video, created by the American Association for Pediatric Ophthalmology & Strabismus, explains what to expect during a child's eye exam with a pediatric ophthalmologist, including answers to questions such as:

  • How can you measure vision in a young child?
  • How long will it take?
  • Why are dilating drops necessary?
  • How do you know if they need glasses?

Is strabismus surgery covered by insurance?

Patients commonly wonder if eye muscle surgery to realign the eyes and fix strabismus is covered by insurance.

Patients commonly wonder if eye muscle surgery to realign the eyes and fix strabismus is covered by insurance.

In a word, yes!

Virtually all health insurances, both private and state-sponsored, cover strabismus surgery, as it is reconstructive, not cosmetic. Our office will be sure to verify this with your insurance provider prior to the surgery date. If there will be any anticipated out-of-pocket costs, we will let you know beforehand.