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Q. Is surgical intervention necessary for mild strabismus?

Answered by
Dr. Arnab Pal
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jul 24, 2020

Hello doctor,

I believe I have mild strabismus, however, it is not very obvious when looking straight ahead but the minute I try to focus on something, or look in another direction (without moving my head) you can clearly see that my right eye is slightly misaligned. Is this something that can be corrected with surgery since it is not present all the time and only in certain scenarios? I am thinking that if they attempted to do a surgical repair that since I would have a rather neutral gaze it might not be apparent until I tried to focus on something else which obviously cannot be done under general anesthesia. I have attached a photo (the top is looking straight on, the bottom is focusing on an object) and you can see it is slightly misaligned. I cannot get an appointment until November, and it is bothering my vision and there is also discomfort in the right eye and was wondering if there was anything I can do in the interim.

Dr. Arnab Pal

Ophthalmology (Eye Care)
#

Hello,

Welcome to icliniq.com.

It is an elaborate and well-detailed query. Now coming back to the clinical condition, if I am correctly understanding it, your right eye seems to deviate outwards towards your ears only when you try to focus on near objects. Right? But they are straight when looking at the distance. The condition you have is called intermittent divergent squint and it is the near type, i.e. it manifests when we are looking at near objects. The cause of such squint at near is convergence insufficiency.

I hope you know that when we look at near objects our eyes converge or move towards each other (try looking at the tip of the nose). You seem to be suffering from an insufficiency of this convergence mechanism and so the eyes do not converge and hence diverge when you focus at near. The good news is that we do not advise surgery as the first treatment for such a condition.

Hence I advise you

1) Convergence exercises (pen/pencil push up exercises and cat card exercises) twice daily for 5 minutes each.

2) If it is not helping even after two to three months of exercises, you should try wearing base in prisms in glass to stimulate convergence (your optometrist knows).

3) The last resort is surgical correction. In your case, we opt for bilateral medial rectus resection. You can call me over video if you cannot get a hold of the eye exercises I have suggested. More often than not the exercises and prism glass suffice.

I hope this helps.


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