Surgery to straighten misaligned eyes in children and adults: how it works, what it can and cannot achieve, and what recovery involves.
Written by our medical board, reviewed quarterlyUpdated 21 January 19708 min read
Who strabismus surgery is for
Strabismus is a misalignment of the eyes, where one eye turns in, out, up or down rather than working in tandem with the other. Strabismus surgery adjusts the muscles that move the eye to bring the eyes into better alignment. It is performed in both children and adults, though the goals can differ.
In children, treatment often aims to restore the eyes' ability to work together and protect the development of vision, and surgery is one part of a broader plan that may include glasses and patching. In adults, surgery may correct a long-standing or newly developed misalignment to relieve double vision and restore comfortable, aligned eyes. Some families and adults travel for this surgery, but candidacy and goals must be set by a specialist after a full orthoptic assessment.
How the surgery works
Each eye is moved by six muscles, and strabismus surgery works by strengthening or weakening specific muscles to rebalance the pull on the eye. A muscle can be detached and reattached slightly further back to weaken it, or shortened to strengthen it, changing how the eye sits. The surgery is performed on the surface of the eye, not inside it, and the eye is never removed from the socket.
In some adults, an adjustable suture technique allows fine-tuning of the alignment shortly after surgery while the patient is awake, which can improve precision. The exact muscles operated on and the amount of adjustment are planned from careful measurements of the misalignment in different directions of gaze, which is why the pre-operative assessment is so detailed.
What strabismus surgery costs and what is included
Costs vary with whether one or both eyes are operated on, how many muscles are involved, and whether an adjustable suture technique is used. In children the surgery is usually done under general anaesthetic, which is part of the package. Because alignment problems in children can be medically important, treatment at home may be covered, so weigh any saving against follow-up needs.
A proper package should cover the orthoptic assessment and measurements, the anaesthetic, the surgery and follow-up visits. Ask whether a second procedure is included if the alignment is under- or over-corrected, since a proportion of patients need an adjustment or repeat surgery to reach the best result. The detailed assessment is integral to a good outcome, so it should never be skipped to save cost.
Choosing a surgeon and clinic
Strabismus is a subspecialty, and children in particular should be treated by a paediatric ophthalmologist or a strabismus specialist working with an orthoptist. Choose a board-certified surgeon at an accredited hospital with JCI, TEMOS or ISO recognition, and ask how many strabismus procedures they perform and how they plan the muscle surgery from your measurements.
For children, also confirm that the centre is set up for paediatric anaesthesia and care. Because some patients need more than one operation and alignment can change over time, particularly in growing children, arrange follow-up with a specialist at home and ensure detailed records of the muscles operated on and the measurements are provided before you travel home.
Recovery and timeline
Recovery from strabismus surgery is usually quicker than patients expect, though the eye looks dramatically red at first. The white of the eye is bloodshot and the eye feels sore, gritty and sensitive for one to two weeks, gradually settling as the redness fades over several weeks. Children often bounce back faster than adults.
You or your child will use anti-inflammatory and antibiotic drops and should avoid swimming and rubbing the eye while it heals. Double vision can occur temporarily as the brain adjusts to the new alignment, and most people return to school or light work within a week or so. The final alignment is assessed once healing is complete, and the brain's adaptation can continue over weeks.
Risks and what if something goes wrong
Strabismus surgery is generally safe and works on the eye's surface rather than inside it, but it is not guaranteed to achieve perfect alignment in a single operation. The most common issue is under- or over-correction, where the eyes are not quite straight afterwards, which may need glasses, prisms or a further procedure.
Other risks include persistent or new double vision, infection, and rarely a stitch-related reaction or a slipped muscle. For children, the anaesthetic carries its own small risks that should be discussed. Because a proportion of patients need a second operation and alignment can drift over time, confirm before you travel who manages complications and ensure a specialist at home can review the result and provide any further treatment that is needed.
Frequently asked
Can strabismus surgery fully straighten the eyes?
It significantly improves alignment for most patients, but a perfect result is not guaranteed in one operation. Some people need glasses, prisms or a second procedure to fine-tune the alignment.
Is the surgery done inside the eye?
No. It is performed on the muscles on the surface of the eye, and the eye is never removed from its socket. This is a common worry that the surgery does not involve.
Is strabismus surgery only for children?
No. It is performed in both children and adults. In children it often protects visual development, while in adults it can correct long-standing misalignment and relieve double vision.
How long does the redness last?
The eye looks very red at first and remains bloodshot for one to two weeks, with the redness fading gradually over several weeks. This appearance is normal and not a sign of a problem.
Will my child need more than one operation?
Sometimes. A proportion of patients, especially children whose eyes are still developing, need a further procedure if the alignment is under- or over-corrected or drifts over time.
Is strabismus surgery painful?
It is done under anaesthetic, so it is not painful during the operation. Afterwards the eye feels sore and gritty for one to two weeks, which is managed with drops and pain relief.
