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Compassionate, Expert Care for Adults With Misaligned Eyes

Many adults living with strabismus have been told that nothing can be done, that they missed their window for treatment in childhood, or that surgery is purely cosmetic. Dr. Lisabeth S. Hall, MD, offers a different perspective and a different outcome. With over 25 years of specialized experience in strabismus surgery and her role as former Director of Pediatric Ophthalmology and Strabismus at New York Eye and Ear Infirmary, Dr. Hall has helped countless adults finally achieve proper eye alignment. Dr. Hall brings this expertise to the Eye Center of New York, where she provides comprehensive evaluation and treatment for adults seeking relief from misaligned eyes.

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What Is Adult Strabismus?

Adult strabismus occurs when the eyes do not align properly, causing one eye to look in a different direction than the other. The misalignment may be constant or intermittent, and it can affect one or both eyes. Approximately 4% of adults in the United States experience strabismus at some point in their lives, making it far more common than many people realize.

Adult strabismus can manifest in several ways, such as:

  • Esotropia: One or both eyes turn inward toward the nose.
  • Exotropia: One or both eyes turn outward toward the ears.
  • Hypertropia: One eye sits higher than the other.
  • Hypotropia: One eye sits lower than the other.

What Causes Strabismus in Adults?

Adults develop eye misalignment for various reasons. Some cases represent a recurrence of childhood strabismus that was previously treated or managed with glasses.

Common causes of adult strabismus include:

  • Recurrence of childhood strabismus
  • Stroke or brain injury
  • Thyroid eye disease (Graves' disease)
  • Diabetes and other systemic conditions
  • Multiple sclerosis or other neurological disorders
  • Head or eye trauma
  • Complications from previous eye surgery
  • Cranial nerve palsies
    Brain tumors or lesions affecting eye movement nerves

In some cases, the cause remains unclear. Regardless of the underlying reason, Dr. Hall can evaluate your condition and develop an appropriate treatment plan.

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Who Is a Candidate for Adult Strabismus Treatment?

You may be a candidate for adult strabismus treatment in New York City if you:

  • Have eyes that appear misaligned or turn in different directions
  • Experience double vision (diplopia) that interferes with daily activities
  • Suffer from eye strain, fatigue, or headaches related to eye alignment issues
  • Had strabismus as a child that has recurred or was never fully corrected
  • Developed eye misalignment following a stroke, head injury, or other medical event
  • Have thyroid eye disease affecting your eye alignment
  • Wear prism glasses and would prefer a more permanent solution
  • Feel self-conscious about the appearance of your eyes
  • Struggle with depth perception or coordination
  • Have difficulty making eye contact in professional or social situations
  • Were previously told you were not a candidate for treatment (advances in techniques have expanded treatment options significantly)

Factors Dr. Hall considers when evaluating candidates include:

  • The type and degree of eye misalignment
  • Whether the strabismus is constant or intermittent
  • The presence and severity of double vision
  • Previous eye surgeries or treatments
  • Underlying medical conditions that may affect treatment
  • Patient goals and expectations
  • Overall eye health and visual potential

There is no upper age limit for strabismus treatment. Dr. Hall has successfully treated patients in their 70s, 80s, and beyond. The key is a thorough evaluation to determine the safest and most effective approach for each individual.

Dr. Lisbeth S. Hall, MD
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Why Choose Dr. Hall for Adult Strabismus Treatment?

Treating adult strabismus requires specialized expertise that goes beyond general ophthalmology. Dr. Hall's background makes her exceptionally qualified to care for adults with misaligned eyes.

  • Extensive surgical experience: Dr. Hall has performed thousands of eye muscle surgeries throughout her career, including many complex adult cases. Her twenty years directing the pediatric ophthalmology and strabismus program at New York Eye and Ear Infirmary provided her with the advanced surgical skills necessary to achieve excellent outcomes in challenging cases.
  • Fellowship training in strabismus surgery: Dr. Hall's fellowship at UCLA's Jules Stein Eye Institute included intensive training in the diagnosis and surgical management of all types of strabismus. This specialized training is essential for the delicate surgical techniques required to properly align the eyes.
  • Understanding of adult-specific considerations: Adult strabismus presents unique challenges compared to childhood cases. Dr. Hall understands how to evaluate the impact of previous surgeries, assess the effects of underlying medical conditions, and develop treatment strategies tailored to adult patients.

Treatment Options for Adult Strabismus

Dr. Hall takes a comprehensive approach to adult strabismus, considering all treatment options before recommending a course of action. Treatment depends on the type and severity of misalignment, the presence of double vision, underlying causes, and individual patient goals.

Non-Surgical Treatments

For some patients, non-surgical approaches can effectively manage strabismus symptoms. Options include:

  • Prism glasses: Prisms incorporated into eyeglass lenses can redirect light to compensate for eye misalignment and reduce or eliminate double vision. Prisms are particularly useful for small-angle strabismus or as a temporary measure.
  • Vision therapy exercises: Certain exercises may help patients with convergence insufficiency, a condition in which the eyes have difficulty working together for near tasks.
  • Botulinum toxin (BOTOX) injections: In selected cases, BOTOX injections can temporarily weaken specific eye muscles to improve alignment. This approach may be used diagnostically or as an alternative to surgery in certain situations.

Strabismus Surgery

Eye muscle surgery is the most common and effective treatment for adult strabismus.

The procedure involves adjusting the tension or position of the muscles that control eye movement to achieve proper alignment.

What to Expect From Strabismus Surgery

Before Surgery

Dr. Hall will perform a comprehensive evaluation, including detailed measurements of your eye alignment, assessment of eye muscle function, and review of any underlying medical conditions. If your strabismus relates to a medical condition, she may coordinate care with other specialists.

During Surgery

The procedure typically takes 45 minutes to two hours, depending on complexity. You will not see or feel the surgery. If adjustable sutures are used, Dr. Hall may perform a brief adjustment while you are awake later that day or the following day.

Recovery

Most patients experience mild discomfort, redness, and a foreign-body sensation for several days after surgery. Over-the-counter pain medication is usually sufficient for comfort. You will use antibiotic and anti-inflammatory eye drops during the healing period. Most patients return to work and normal activities within three to five days, though heavy physical activity and swimming should be avoided for several weeks.

The eyes may initially appear overcorrected or undercorrected as healing progresses. Final alignment typically stabilizes four to six weeks after surgery. In some cases, additional surgery may be needed to optimize alignment.

Results

Approximately 70 to 80% of adults achieve satisfactory eye alignment with a single surgical procedure. Many patients experience improvement in double vision, expanded visual fields, and restored depth perception. Beyond functional improvements, patients consistently report enhanced self-confidence and quality of life.

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Is Strabismus Surgery Covered by Insurance?

It is important to note that adult strabismus surgery in New York is considered reconstructive, not cosmetic. Strabismus treatment addresses functional disability, including double vision, abnormal head positioning, and impaired binocular vision.

However, Dr. Hall's services at the Eye Center of New York are offered on a private-pay basis. This approach ensures she can dedicate appropriate time to each patient's evaluation and surgical planning without insurance-imposed limitations. Our team will provide transparent fee information, and we can supply documentation for potential out-of-network insurance reimbursement.

Schedule Your Adult Strabismus Consultation

Whether you are experiencing double vision, self-consciousness about eye alignment, or simply want to understand your options, Dr. Hall will provide a thorough evaluation and honest guidance.

Contact the Eye Center of New York to schedule your consultation today.

Frequently Asked Questions Adult Strabismus

What are adjustable sutures, and will Dr. Hall use them in my surgery?

Will the suture adjustment be painful?

I have had strabismus surgery before, which did not work. Can I still have surgery again?

Will I have double vision after surgery?

How soon after surgery can I return to work?

Will I still need to wear glasses after strabismus surgery?

Can strabismus come back after surgery?

I developed strabismus after cataract surgery. Can this be fixed?

My strabismus is related to thyroid eye disease. Is surgery still an option?

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What are adjustable sutures, and will Dr. Hall use them in my surgery?

Adjustable sutures are special slip-knots that allow the surgeon to fine-tune eye alignment after surgery while you are awake. Dr. Hall often uses this technique in adult patients because it provides an opportunity to optimize results before the muscles permanently heal in place.

Will the suture adjustment be painful?

The adjustment is performed with numbing drops and typically causes only mild pressure or discomfort, not significant pain. Most patients find the anticipation worse than the actual experience, which takes only a few minutes.

I have had strabismus surgery before, which did not work. Can I still have surgery again?

Yes, previous strabismus surgery does not prevent you from having additional procedures. Dr. Hall has extensive experience with reoperations and understands how to work with previously operated muscles to achieve improved alignment.

Will I have double vision after surgery?

Some patients experience temporary double vision in the days or weeks following surgery as the brain adjusts to the new eye position. In most cases this resolves, though patients who had double vision before surgery may notice changes in their double vision pattern during the healing process.

How soon after surgery can I return to work?

Most patients return to desk work and normal activities within three to five days, though your eyes will still be red and healing. Jobs requiring heavy physical activity, swimming, or dusty environments may require a longer recovery period of several weeks.

Will I still need to wear glasses after strabismus surgery?

Strabismus surgery corrects eye alignment but does not change your glasses prescription. If you needed glasses before surgery for nearsightedness, farsightedness, or astigmatism, you will still need them afterward.

Can strabismus come back after surgery?

Eye alignment can drift over time in some patients, and not all cases achieve perfect alignment with one procedure. Dr. Hall will discuss realistic expectations for your specific type of strabismus and what factors may influence long-term stability.

I developed strabismus after cataract surgery. Can this be fixed?

Yes, strabismus following cataract surgery or other eye procedures is a recognized condition that can often be corrected. Dr. Hall will evaluate the cause of your misalignment and determine the most appropriate surgical approach.

My strabismus is related to thyroid eye disease. Is surgery still an option?

Strabismus surgery can be very effective for patients with thyroid-related eye muscle changes, though timing is important. Dr. Hall typically recommends waiting until the thyroid condition has been stable for several months before proceeding with surgery.

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