One of the most common misconceptions about strabismus is that it is only a childhood condition.
While most patients develop strabismus as children, adults can absolutely develop strabismus. In fact, new-onset eye misalignment in adulthood is something I evaluate regularly.
Patients often notice that one eye suddenly seems to drift inward or outward. Others experience double vision, difficulty reading, headaches, or a sense that their eyes are no longer working together normally.
The causes can range from relatively benign age-related changes to neurological conditions that require prompt evaluation.
The important thing to understand is this:
Adult strabismus is common, treatable, and often deserves medical attention.
What Is Strabismus?
Strabismus occurs when the eyes are not properly aligned.
One eye may turn inward, outward, upward, or downward relative to the other eye.
Because the eyes are pointing in different directions, the brain receives different visual information from each eye.
Children and adults often respond to this situation very differently.
Young children frequently adapt to misalignment by suppressing one eye's image. Adults, on the other hand, are much more likely to experience double vision when eye alignment changes.
Why Would Someone Develop Strabismus As An Adult?
There are many possible causes.
Some of the most common include:
- Poor vision in one eye
- Longstanding childhood strabismus that gradually worsens
- Age-related changes in the eye muscles and surrounding tissues
- Thyroid eye disease
- Cranial nerve palsies
- Head trauma
- Stroke
- Brain tumors
- Myasthenia gravis
Sometimes the cause is obvious. Sometimes it requires additional testing.
This is one reason adult-onset strabismus should never be dismissed as "just cosmetic."
Is Adult Strabismus A Medical Problem Or A Cosmetic Problem?
Often both, but can be either.
Many people seek treatment because they notice that one eye has begun drifting and it “doesn’t look right.”
Others have had the issue for a long time and, for many reasons, want to do something about it now.
Some people feel ugly or embarrassed by their appearance.
Any and all of these are legitimate reasons to seek care. What’s cosmetic to one person could be a very big deal to another.
However, the functional symptoms are frequently more significant.
Medically, patients with strabismus may experience:
- Double vision
- Difficulty reading
- Problems driving
- Eye strain
- Headaches
- Loss of depth perception
- Fatigue during visual tasks
In these situations, strabismus is much more than an appearance issue.
It can interfere with daily activities and quality of life.
Does Adult Strabismus Always Cause Double Vision?
No.
Some adults develop obvious misalignment without significant double vision.
Others develop severe double vision from relatively small alignment changes.
The reason has to do with how the brain processes visual information.
Some patients are able to adapt to the change. Others cannot.
The relationship between eye alignment and symptoms is not always straightforward.
This is why a comprehensive examination is important.
How Is Adult Strabismus Treated?
Treatment depends entirely on the underlying cause.
Options may include:
- Observation
- Glasses
- Prism lenses
- Treatment of an underlying medical condition
- Botulinum toxin injections
- Strabismus surgery
No single treatment works for every patient.
The goal is to create the safest and most effective plan for the specific type of strabismus present.
When Should An Adult Seek Evaluation?
Any adult who develops new eye misalignment or new double vision should be evaluated promptly.
While some causes are relatively benign, others can be the first signs of neurologic or systemic disease that requires medical attention.
Even when the underlying cause has already been identified, treatment may still significantly improve visual comfort and quality of life.
Many patients are surprised to learn that options exist.
In Conclusion
Yes, adults can absolutely develop strabismus later in life.
New-onset eye misalignment is not uncommon and can occur for many different reasons, ranging from age-related changes to neurological conditions.
Because adult strabismus often causes double vision, impaired depth perception, reading difficulties, and eye strain, it is important to determine the underlying cause and discuss treatment options.
The good news is that adult strabismus is usually treatable.
Whether treatment involves prisms, medications, observation, or surgery, the goal is the same: helping the eyes work together as comfortably and effectively as possible.
Dr. Eric Lichtenstein provides specialized evaluation and treatment of adult strabismus, double vision, and eye muscle disorders.
Contact The Pediatric Eye Center to schedule a consultation
