Crossed Eye Surgery – Strabismus

Medically reviewed by: Op. Dr. Alim Hüseynov · Last updated: 7 September 2026

What is strabismus?

Strabismus is a misalignment of the eyes: while one eye fixes on the target, the other turns inward, outward, upward or downward. It may be constant or intermittent, and it can begin in childhood or in adult life.

Why it matters in children

A child’s visual system is still developing. When the eyes are not aligned, the brain suppresses the image from the deviating eye, and that eye can lose visual potential — amblyopia, or “lazy eye”. Treatment is far more effective the earlier it begins, which is why any suspected misalignment after the age of about four months should be examined rather than watched.

Common types

• Esotropia (inward turn): including accommodative esotropia related to uncorrected hypermetropia
• Exotropia (outward turn): often intermittent at first, more evident when tired or unwell
• Vertical deviations and paralytic strabismus due to a cranial nerve palsy
• Adult-onset strabismus: may follow thyroid eye disease, trauma, neurological disease or long-standing childhood deviation

Examination

A full assessment includes visual acuity, cycloplegic refraction, cover testing with prism measurement in all positions of gaze, ocular motility, binocular vision and stereopsis testing, and a dilated fundus examination. In adults, and in any acute-onset deviation with double vision, neurological assessment and imaging may be required.

Treatment

• Glasses: accommodative esotropia can improve substantially with full hypermetropic correction alone
• Amblyopia treatment: patching or atropine penalisation to develop the weaker eye — this precedes and supports surgery
• Prisms: for small deviations and for symptomatic double vision
• Botulinum toxin: in selected deviations, particularly some acute palsies
• Surgery: strengthening or weakening the eye muscles to restore alignment. It is performed under general anaesthesia in children and often under local anaesthesia in adults; it is a day-case procedure

Surgery in adults is not only cosmetic — it can restore binocular function, relieve double vision and improve the field of vision. More than one procedure is sometimes needed, and this should be discussed before treatment.

Frequently asked questions

At what age should a squint be examined?

Any misalignment persisting beyond about four months of age should be examined. Early treatment protects visual development.

Will my child grow out of it?

True strabismus does not resolve by waiting. Some pseudo-strabismus caused by facial features is not a real deviation, which is why examination is needed.

Can glasses alone correct a squint?

In accommodative esotropia caused by hypermetropia, full spectacle correction can substantially or completely correct the deviation.

Is surgery in adults only cosmetic?

No. It can relieve double vision, restore binocular function and expand the field of vision.

Might more than one operation be needed?

Yes. Depending on the type and size of the deviation, a second procedure is sometimes required.

Medically reviewed by

Op. Dr. Alim Hüseynov — Ophthalmologist — refractive laser surgery, cornea and oculoplastic surgery, Nişantaşı Hastanesi Göz Merkezi. Our doctors

This page is for general information and does not replace an examination by a doctor. Treatment decisions are made after examination and diagnostic tests.