Key Takeaways
- Adult strabismus often comes from a problem with the eye muscles, the nerves that control them, or both.
- Health conditions such as diabetes, myasthenia gravis, stroke, and brain tumors can be linked to new eye misalignment.
- Head injuries, accidents, and damage to eye muscles during eye surgery can also lead to strabismus.
- Some adults have an old childhood misalignment that becomes noticeable with age, and some cases have more than one contributing factor.
- The cause helps guide the treatment plan, and it is never too late to treat strabismus.
- Conestoga Eye offers expert adult strabismus and double vision care in Lancaster and Hershey, PA, and patients can request an appointment to find out what is behind their symptoms.
Common Causes of Strabismus in Adults
The eyes work as a team. Six muscles control eye movement, and the brain directs those muscles. Strabismus can happen when something affects the eye muscles, the nerves that control them, or both, as outlined in this guide to the causes of adult strabismus from the American Academy of Ophthalmology. The table below groups the main causes.
| Possible Cause | Examples | How It May Affect Eye Alignment |
|---|---|---|
| Health conditions | Diabetes, myasthenia gravis, stroke, brain tumors | Can involve the eye muscles, the nerves that control them, or both |
| Head injury or accident | A blow to the head or an accident near the eye | Can damage the nerves or muscles that move the eye |
| Eye surgery | A procedure for another eye problem | Can damage the eye muscles during surgery |
| Age-related changes | Trouble turning the eyes inward for near tasks or outward for distance | Symptoms may get worse when you are tired |
| Unnoticed childhood strabismus | A mild misalignment that was missed when you were young | Can become easier to see as you get older |
Neurological and Muscular Causes of Adult Strabismus
Eye movement depends on a chain of connections. The brain sends signals through nerves to the muscles around the eye. A problem anywhere along that chain can pull the eyes out of line.
A cranial nerve palsy, which is weakness or damage in one of the nerves that move the eye, can result from pressure on the nerve, poor blood flow, infection, or inflammation. A fourth cranial nerve palsy is often caused by trauma, poor blood flow in tiny blood vessels, or an older childhood problem that the brain can no longer keep under control. In myasthenia gravis, the trouble is where the nerve meets the muscle, and the eye muscles are especially prone to tiring. For more detail on these causes, see this clinical overview of diplopia, or double vision, from EyeWiki.
Health Conditions Linked to New-Onset Strabismus
Diabetes, myasthenia gravis, brain tumors, and stroke are among the health problems that may be behind strabismus in adults. This is one reason a medical eye exam looks beyond glasses. At Conestoga Eye in Lancaster and Hershey, a comprehensive medical eye exam for adults looks at the health of the eyes and the visual system, and the providers have years of experience seeing and treating patients with diabetes and double vision.
Strabismus Risk Factors and Cases With No Single Clear Cause
The risk factors for adult strabismus mirror its causes: certain health conditions, head injury, eye surgery, aging, and a history of misaligned eyes in childhood. A childhood strabismus that went unnoticed can show up as a person ages. Aging can also make it harder for the eyes to turn inward or outward, and tiredness can make symptoms worse, as explained in this answer to a patient question about eye crossing and fatigue.
In some adults, no single cause stands out. An old childhood misalignment, age-related changes, and tiredness can all play a part together. That is why a complete evaluation matters even when the cause is not obvious.
How to Fix Strabismus: Treatment Options Shaped by the Cause
The cause, the severity of the misalignment, and the patient's goals all guide the plan. Finding the cause can also help an eye doctor spot health concerns that need attention outside the eye clinic. At Conestoga Eye, adults with strabismus and double vision see David Silbert, MD or on of our specialty-trained optometrists, depending on their goals.
Prism Glasses for Double Vision
Hayley Woodall, OD, Sara Berteramo, OD, and Daniel Byron, OD, perform prism refractions for patients whose double vision can be corrected with a prism in their glasses or a prism patch. A prism is a clear, wedge-shaped lens that bends light. Prisms can help some people with mild double vision see one image instead of two.
Strabismus Surgery
Patients who want to explore surgery see Dr. David Silbert, an ophthalmologist, for a full exam and a talk about their options. An ophthalmologist is a medical eye doctor who can also perform eye surgery. Surgery is the most common treatment for strabismus in adults. The surgeon loosens, tightens, or moves certain eye muscles so the eyes line up and work together. Surgery is usually done as an outpatient procedure, more than one surgery may be needed, and patients can usually return to normal daily activities within a few days.
You do not have to live with the discomfort of misaligned eyes, and it is never too late to treat strabismus.
Find Out What Is Behind Your Strabismus at Conestoga Eye
Adult strabismus can come from eye muscle or nerve problems, health conditions, injuries, eye surgery, or age-related changes, and sometimes several factors work together. A full evaluation points toward the right plan, whatever the cause.
Adults in Lancaster or Hershey who want answers can request an appointment for adult strabismus care at Conestoga Eye or read more about strabismus and double vision care for adults.
Frequently Asked Questions
What causes strabismus in adults?
Adult strabismus can come from a problem with the eye muscles, the nerves that control them, or both. Health conditions, head injuries, eye surgery, and age-related changes are all possible causes.
Can diabetes cause strabismus?
Diabetes is one of the health problems that can lead to adult strabismus. Adults with diabetes can have a medical eye exam to check for changes in vision and eye health.
Can an injury cause strabismus later in life?
Yes. Accidents and head injury are possible causes, and trauma is a common cause of fourth cranial nerve palsy, which can lead to double vision.
How can adult strabismus be fixed?
Treatment depends on the cause and the patient's goals. Conestoga Eye offers prism glasses or a prism patch for some patients with double vision, and a surgery consultation for those who want to explore surgery.
Where can I find an eye doctor for strabismus near me?
Conestoga Eye provides adult strabismus and double vision care at its Lancaster and Hershey offices. Patients can request an appointment online or call (717) 541-9700.
