What exercises can be done to strengthen weak eye muscles in adults and children with conditions like strabismus, amblyopia, or presbyopia?

Eye Muscle Exercises: Evidence-Based Recommendations

Eye exercises have limited but specific applications in strabismus management—they are effective only for convergence insufficiency with small-to-moderate angle exodeviations (≤20 prism diopters), but do not strengthen weak eye muscles in most other conditions including amblyopia or presbyopia. 1

When Eye Exercises Actually Work

Convergence Insufficiency (The Only Clear Indication)

Orthoptic therapy may improve fusional control in both children and adults with convergence insufficiency and small-to-moderate angle exodeviations (≤20 prism diopters), with the goal of strengthening fusional convergence amplitudes. 1

Ideal candidates include:

• Patients with convergence insufficiency type exotropia (exotropia greater at near than distance) 1
• Those experiencing asthenopic symptoms with near viewing, particularly during reading 1

Specific exercise protocols that work:

• Near point of convergence exercises on an accommodative target are useful when the near point of convergence is distant 1
• Convergence exercises with base-out prism may be beneficial once the near point of convergence improves 1
• Computer-based convergence exercises and in-office orthoptics are alternative treatment modalities 1
• Treatment should be tapered as symptoms improve and may need resumption if symptoms recur 1

When Eye Exercises Do NOT Work

Amblyopia

Eye exercises do not treat amblyopia—the primary treatments are patching therapy (2-6 hours daily) or atropine penalization of the better eye, not muscle strengthening exercises. 1, 2 Treatment of amblyopia may improve fusional control and decrease the angle of exodeviation, but this occurs through forcing use of the amblyopic eye, not through muscle strengthening. 1

Presbyopia

Exercise for presbyopia is fundamentally ineffective at improving accommodation. 3 A 2021 study found that after 2 months of near-far viewing exercises, accommodation and near visual acuity did not improve, though pupillary size decreased and convergence amounts increased slightly. 3 Any reported satisfaction improvements appear related to enhanced miosis during near viewing rather than actual muscle strengthening. 3

Most Forms of Strabismus

For constant strabismus, large-angle deviations, or strabismus not related to convergence insufficiency, surgical intervention is the primary treatment—not exercises. 1 Orthoptic exercises to address diplopia and asthenopia can be considered in select cases, but prisms and surgery remain the mainstays of treatment. 1

Alternative Non-Surgical Treatments (Not Exercises)

Optical Correction

Refractive correction should be optimized first, including correction of hyperopia and appropriate bifocal or progressive lenses for adults approaching presbyopia. 1

Prism Therapy

• Prisms can address some forms of diplopia in adult strabismus 1
• Base-in prism can be included in eyeglasses for symptomatic convergence insufficiency exotropia refractory to exercises, though one study found this no better than placebo in children 1

Patching Therapy

Part-time patching (2-6 hours daily) may improve fusional control and/or reduce the angle of strabismus, particularly in the 3-10 year age group. 1

Critical Pitfalls to Avoid

• Do not prescribe eye exercises for amblyopia treatment—use patching or atropine penalization instead 2
• Do not recommend exercises for presbyopia—they are theoretically and practically ineffective at restoring accommodation 3
• Do not delay surgical referral for constant or large-angle strabismus while attempting prolonged exercise therapy 1
• Ensure proper diagnosis before prescribing exercises—convergence insufficiency must be confirmed with orthoptic testing 1
• Recognize that exercises work only for specific convergence problems, not generalized "weak eye muscles" 1