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    Sharing Mayo Clinic: Seeing straight thanks to surgery for crossed eyes

Sight is the most dominant sense. It affects people's ability to perceive and move through the world, but it also affects how people are perceived by others.

Eye contact during a conversation shows attentiveness, respect, confidence and understanding. Each person has a different comfort level with sustained eye contact, but this part of nonverbal communication may be difficult for people who have crossed eyes, or strabismus, because one or both eyes point in a different or unexpected direction.

George Frank can relate. The 57-year-old Menomonie, Wisconsin, resident has struggled with strabismus for 42 years.

Like many others, George needed glasses to correct his vision, beginning in elementary school. But his eyes were otherwise healthy and functioning properly. When he was 15, he suffered a head injury during a motorcycle accident. This accident reduced his vision and caused his right eye to drift out of alignment.

Strabismus, also called crossed eyes or eye misalignment, is common. This condition affects approximately 4% of people. It can be caused by problems with the eye muscles or the nerves that control eye movements. It also can develop after a stroke or head injury, such as in George's case.

Esotropia strabismus is an inward drift of the eyeball. George had exotropia strabismus, which is an outward drift of the eyeball. Strabismus in children often requires patching of one eye to prevent vision loss from not using the misaligned eye. New strabismus in adults usually requires immediate attention to address the cause.

As he got older, George's vision worsened as his eyes became increasingly misaligned. He eventually lost depth perception and had occasional episodes of double vision. This made reading difficult and driving impossible. He also was self-conscious that his eyes were pointing in different directions and how this affected communicating with others.

"When I would talk with people, my right eye would drift off to the side. It was lazy," says George. "They probably didn't think I was paying attention. That was hard."

Hope for clearer vision

George wasn't sure what could be done to correct his strabismus. But he received good news during an appointment with Dany Najjar, M.D., an ophthalmologist at Mayo Clinic Health System who sees patients in Eau Claire and Menomonie. A surgical treatment option could be completed in Eau Claire, about 30 minutes from his home.

Dr. Najjar referred George to Sasha Mansukhani, M.B.B.S., who also is an ophthalmologist at Mayo Clinic Health System.

"Over time, Mr. Frank's strabismus got worse to the point that it was constant when I met him for the first time," says Dr. Mansukhani, who specializes in correcting eye misalignment. "He had a moderate to severe exotropia."

Dr. Mansukhani explained to George that a surgery could correct his eye misalignment and other symptoms he was experiencing.

"Strabismus surgery either tightens a muscle or loosens the effect of the eye muscles to allow the brain to use the eyes together," says Dr. Mansukhani. "During the surgery, we detach the eye muscles from the eyeball and reattach them with the eye in a better position to allow the eyes to be aligned better with one another."

Many adults with strabismus are unaware that a surgical treatment option is available, explains Dr. Mansukhani. "I hear too often from my adult patients that they thought they couldn't have strabismus surgery, it could not be fixed as an adult, or that strabismus surgery is a cosmetic procedure. Nothing could be further from the truth," she says.

There are many functional benefits of strabismus surgery, including improvement of depth perception, improving double vision and relieving eye strain. In addition, it improves social interactions and confidence.

"I can't emphasize enough the functional and psychosocial benefits of strabismus surgery and that it is not a cosmetic procedure," says Dr. Mansukhani. "Strabismus is often a source of embarrassment and a source of poor confidence. Patients report not being taken seriously or that they're not trusted as much. The psychosocial improvement of strabismus surgery can be equally important to the functional benefits. In these situations, one plus one equals three when your eyes are well-aligned."

Surgical option

George approached the surgery with his normal positive attitude. "I told her, 'Let's do it,'" he says. "I was really excited to hop on and get it done."

Strabismus surgery is a same-day surgery, which means patients are not admitted into the hospital and can recover safely at home. Most patients can expect a full recovery in about six weeks. George's surgery took place in early November 2021.

"I had no pain or discomfort after surgery. Dr. Mansukhani tightened all the nuts and bolts in my eye when she was in there," George says with a laugh. "I'm so glad that I found her and her team."

Dr. Mansukhani explains that while George's surgery was the standard procedure, some patients' conditions qualify them for an adjustable suture strabismus surgery.

"This surgery allows us to tweak or to fine-tune the muscle position after the patient wakes up from general anesthesia," she says. "We can further pull up the muscle or let the muscle back a little before we secure it. This gives us the chance to customize the eye position to the individual patient. It's one more tool in our toolbox that we can offer to our patients."

While healing from either standard or adjustable suture strabismus surgery, patients gradually notice improvement in the eye position and reduction in symptoms they were previously experiencing.

"It does take a while for the brain to adjust to the new eye position. But after the process of healing and readjustment, it is very rewarding for a lot of our patients to have their eyes better aligned," says Dr. Mansukhani.

Seeing bright future ahead

George's recovery is right on track, and he is seeing the difference.

"I can read now, and my eye doesn't drift. It's easier to watch TV. When I look forward, I can see the stuff next to me without looking at it. My peripheral vision is much better," he says. "My eye is 200% better. I appreciate it very much. Now I can finally see straight again."

Throughout his journey, George's optimistic attitude has had a positive effect on Dr. Mansukhani and the care team.

"Mr. Frank has a lot of positive energy, and he's one of those patients who touches the lives of everyone he encounters," she says. "He has this unique way of channeling any negative situation or circumstance into a positive, lighthearted experience. He's one patient that I won't forget."


This story also is published on the Mayo Clinic Health System blog. You can find it there and share it with others.