From the Guidelines
Treatment of strabismus in an older adult typically involves a comprehensive approach that may include both non-surgical and surgical options, with the goal of optimizing functional visual status and addressing psychosocial concerns, as outlined in the adult strabismus preferred practice pattern 1. The treatment approach should be individualized, taking into account the cause and type of strabismus, as well as the patient's overall health and quality of life.
- Non-surgical management options may include:
- Prism glasses to align images and reduce double vision
- Vision therapy exercises to improve eye coordination
- Treating underlying medical conditions, such as diabetes, hypertension, or thyroid disease
- Surgical correction may be recommended for persistent or severe strabismus causing functional problems, with a success rate of approximately 80% in achieving improved alignment 1. The decision to undergo surgery should be made after a thorough discussion of the potential benefits and risks, as well as the patient's expectations and goals.
- It is essential to note that while surgery can improve eye alignment and reduce double vision, it may not completely restore normal binocular vision if the strabismus has been present for many years 1. A multidisciplinary approach, including consultation with an ophthalmologist and other specialists as needed, may be necessary to ensure the best possible outcome for the patient.
- The patient should be monitored and observed if symptoms are mild or occasional, or if the patient is opposed to treatment, and a comprehensive eye examination should be performed to determine the cause and type of strabismus 1. Surgical correction, such as recessions of restricted muscles, may be the mainstay of treatment for certain types of strabismus, such as thyroid eye disease, and adjustable sutures may be useful in select cases 1.
From the Research
Treatment Options for Strabismus in Older Adults
- Botulinum toxin injections can be used to treat strabismus in older adults, particularly for preoperative evaluation of possible postoperative diplopia, acute paretic loss of ocular muscle function, and strabismus in acute Graves' disease 2
- Strabismus surgery can be performed through a cul-de-sac incision in older patients, with slight modifications to prevent excessive manipulation of the incision and reduce the risk of tearing the conjunctiva 3
- Surgical interventions are pursued in approximately 32% of patients with strabismus older than 60 years, with the majority of patients having an acquired underlying etiology of misalignment 4
- Strabismus surgery can have a significant impact on health-related quality of life in adults, with improvements in functional and psychosocial factors, as measured by questionnaires such as the Amblyopia and Strabismus Questionnaire and the Adult Strabismus-20 5
- Botulinum toxin can also be used to stabilize ocular alignment in patients with decompensated strabismus, with almost half of patients benefiting from this treatment without requiring surgical intervention 6
Considerations for Treatment
- The choice of treatment for strabismus in older adults depends on the underlying etiology of misalignment, the presence of diplopia, and the patient's overall health status 4
- Botulinum toxin injections may be a less invasive alternative to surgery for some patients, but may require repeated injections to maintain the desired effect 2, 6
- Strabismus surgery can be effective in improving ocular alignment and reducing symptoms, but may also have potential complications, such as conjunctival tears 3