Adult Strabismus Treatment Options: Including Botox for Eye Alignment

Adult strabismus occurs when the eyes are not aligned and do not point in the same direction. One eye may turn inward, outward, upward or downward. As a result, the brain receives two different visual images.

Consequently, many patients develop double vision (diplopia) or difficulty focusing.

Adult strabismus may develop for several reasons. For example, it can occur due to childhood strabismus that returns later in life, nerve palsies affecting the eye muscles, trauma or neurological conditions.

Fortunately, several treatment options are available. Depending on the cause and severity of the misalignment, treatment may include observation, glasses, Botox injections, surgery or occluding one eye to eliminate double vision.

Key Points

• Adult strabismus causes misalignment of the eyes
• Double vision is a common symptom
• Several treatment options are available
• Botox injections can temporarily relax eye muscles
• Surgery may provide a more permanent correction

Symptoms of Adult Strabismus

Symptoms vary depending on the type and severity of the eye misalignment.

Common symptoms include:

• double vision
• headaches or eye strain
• difficulty focusing
• problems with depth perception
• visible eye misalignment

In addition, some patients tilt their head or close one eye to reduce double vision.

Five Treatment Options for Adult Strabismus

Treatment depends on the cause of the eye misalignment, the size of the deviation and the symptoms experienced by the patient.

1. Observation

In some cases, no treatment is required.

For example, if the eye misalignment is small and does not cause double vision, doctors may recommend monitoring the condition.

Regular examinations help ensure the alignment remains stable.

2. Glasses or Prism Correction

Glasses may improve eye alignment in certain situations.

Prism lenses redirect light entering the eye so that images align more closely between the two eyes. As a result, prisms can reduce or eliminate double vision.

However, prisms are usually most effective for smaller eye deviations.

3. Botox Treatment for Strabismus

Botox (botulinum toxin) injections can be an effective treatment option for certain types of adult strabismus. The medication works by temporarily weakening an overactive eye muscle. As a result, the opposing muscle can pull the eye into a more balanced position, which may improve alignment and reduce double vision.

In some patients, the improvement persists even after the pharmacological effect of the injection wears off. This occurs when the eyes return to a position within the patient’s binocular fusional range, allowing the brain to maintain alignment naturally.

Botox can be particularly useful in several situations. For example, it may be used in patients with recent onset strabismus, in those who have had previous unsuccessful surgery, or when surgery is not appropriate at the time. In addition, Botox injections can sometimes be used as a temporary trial to determine whether surgical realignment of the eyes might lead to postoperative double vision.

Clinical research has also demonstrated that repeated botulinum toxin injections can maintain good eye alignment and improve quality of life in adults with strabismus when surgery is not indicated.

Dr Shanel Sharma has also contributed to research on the use of botulinum toxin for maintaining eye alignment in adults with strabismus, published in the British Journal of Ophthalmology. This paper examined patients receiving long-term botulinum toxin injections for control of eye misalignment and found that many patients maintained good alignment and reported quality-of-life scores similar to normal controls.

4. Strabismus Surgery

Strabismus surgery adjusts the position or strength of the eye muscles.

During the procedure, the surgeon may reposition or shorten specific muscles in order to improve eye alignment.

Surgery is often recommended for larger or long-standing deviations.

5. Occluding One Eye

Another treatment option involves blocking vision from one eye.

This may be achieved using:

• an eye patch
• opaque tape on glasses
• special occlusive contact lenses

By blocking vision from one eye, the brain receives only one image. Consequently, double vision disappears.

However, this option reduces depth perception and binocular vision.

Assessment for Adult Strabismus in Sydney

A detailed eye examination is required to determine the cause of strabismus.

At Eye & Laser Surgeons in Sydney, patients undergo specialised testing of eye movements and binocular vision.

Dr Shanel Sharma assesses and manage patients with adult strabismus and double vision.  Book an appointment now.

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FAQ

Can Botox permanently fix strabismus?

In around 5% of patients, eye alignment can remain stable even after the Botox effect fades. In these cases, the injection allows the eyes to move back into the patient’s binocular fusional range, enabling the brain to maintain alignment without further treatment.

Is strabismus surgery always necessary?

Not always. Some patients benefit from non-surgical options such as glasses, Botox injections, or observation.

Botox can also be useful in patients who are not suitable for surgery. For example, it may be offered if a patient has previously had unsuccessful surgery, if surgery is not convenient at the time, or as a temporary treatment.

In addition, Botox can sometimes be used as a “test treatment” to assess whether correcting the eye alignment might cause double vision before considering permanent surgery.

Can adults develop strabismus later in life?

Yes. Strabismus may occur due to nerve problems, trauma or neurological conditions.