From the Guidelines
Strabismus surgery is typically performed between 6 months and 2 years of age, with early intervention often recommended for infantile esotropia to promote better binocular vision development. The timing of strabismus surgery depends on several factors, including the type and severity of the strabismus, whether it's constant or intermittent, and how well the child responds to non-surgical treatments 1. According to the preferred practice pattern for esotropia and exotropia, achieving binocular alignment early in life, before age 2 years, to within 10 prism diopters of orthotropia increases the likelihood of achieving binocularity and may decrease the risk for the development of dissociated vertical deviation 1.
Some key considerations for the timing of strabismus surgery include:
- The type of strabismus: Infantile esotropia may benefit from early surgery, while other types may be managed with non-surgical approaches initially 1.
- The severity of the strabismus: Larger angle deviations may require earlier surgical intervention 1.
- The child's response to non-surgical treatments: If eyeglasses, patching, or eye exercises are not effective, surgery may be considered earlier 1.
It's essential to note that the decision for early surgery is based on the understanding that the visual system develops rapidly in the first few years of life, and correcting eye alignment during this critical period can promote normal visual development and prevent amblyopia (lazy eye) 1. However, some forms of strabismus may benefit from delayed surgery, and the ophthalmologist will determine the optimal timing based on the individual child's condition.
In terms of specific age ranges, strabismus surgery can be performed as early as 4 to 6 months of age in certain cases, though most surgeries typically occur between 6 months and 2 years of age 1. The American Academy of Ophthalmology recommends that children with esotropia should undergo surgical correction if eyeglasses and amblyopia management are insufficient to align the eyes, and strabismus surgery should be performed only when more conservative methods have failed or are unlikely to be of benefit 1.
From the Research
Age of Strabismus Surgery
- The optimal age for strabismus surgery is a topic of debate, with some studies suggesting early intervention and others recommending delayed surgery 2, 3.
- A study published in 2005 found that children who underwent early surgery (at 6-24 months) had better gross stereopsis at age six compared to those who had late surgery (at 32-60 months) 2.
- Another study published in 2008 found that early treatment of infantile strabismus with botulinum toxin A injection improved horizontal deviation in 82.4% of cases, and only 35% of cases required secondary surgery 4.
- A 2014 review found that there is no conclusive evidence on the optimal timing of strabismus surgery in children with amblyopia, and more research is needed to determine the best approach 5.
- A 2023 study found that delayed strabismus surgery in early-onset strabismus can still improve stereopsis, especially in patients with exodeviations and those who present at a younger age 6.
- An animal study published in 2003 found that early correction of strabismus in macaque monkeys prevented maldevelopment of eye movements driven by cerebral motor pathways, suggesting that early intervention may be beneficial for brain development 3.