Strabismus, or squint, is a misalignment of the two eyes: one fixes on the target while the other turns in, out, up or down. In children the brain often suppresses the image from the deviating eye, which can lead to lasting amblyopia, a "lazy eye". In adults the more common consequences are double vision, eye strain, the discomfort of an eye that will not hold its alignment, and a visible turn that can weigh on confidence and on how others make eye contact.
Many adults assume it is too late to do anything, especially if they had surgery as a child and the eye has drifted again. That is often not the case. This page focuses on adult strabismus: what an assessment looks for, how the muscle operation works, how a stay in Istanbul is organised and what recovery and risks look like.
Is surgery the right step for your squint?
Management starts with a full examination, not with a date for surgery. It includes measuring the deviation in different positions of gaze, refraction under cycloplegia (drops that relax focusing), an assessment of binocular vision and an examination of the back of the eye. Some deviations are fully corrected by the right glasses, particularly where uncorrected long sight is driving the turn, and operating in that situation would be a mistake. Small deviations causing double vision can sometimes be managed with prisms built into glasses. Botulinum toxin injected into an eye muscle is an option in selected cases.
Surgery is worth discussing when the deviation is stable and well measured, glasses and prisms are not enough, and your goals are clear: less double vision, a more comfortable field of single vision, a straighter appearance, or a combination. Improving appearance and social ease is a legitimate reason, not a trivial one.
It is better to wait or follow another route if:
- the squint appeared suddenly in adulthood: a neurological or orbital cause must be looked for before surgery is discussed at all;
- it is linked to a recent nerve palsy, which can recover on its own; surgeons usually wait for the measurements to stop changing, often for several months;
- it is caused by thyroid eye disease that is still active; the condition should be stable first;
- the measurements vary from one visit to the next;
- in a child, amblyopia has not yet been treated with glasses and patching, which come before any operation.
Strabismus surgery is often covered by public health systems at home. It is worth checking what is available near you, if only because orthoptic follow-up is easier close to home.
How strabismus surgery is performed
The operation works on the muscles that move the eye, weakening or strengthening their action to restore alignment. The eye is not removed from its socket, as many people fear. The surgeon opens the thin clear membrane over the white of the eye, reaches the muscle and either moves its attachment further back to weaken it, or shortens or tightens it to strengthen it, then closes the membrane with fine absorbable stitches. One or more muscles may be treated, on one or both eyes, depending on the measurements.
In adults, some surgeons use adjustable sutures: the final position of a muscle is fine-tuned a few hours after surgery or the next day, with the eye numbed, once you are awake and can look at targets. Not every case is suitable, and your surgeon will explain whether it applies to you.
The operation usually takes 45 to 90 minutes, depending on how many muscles are involved, and is generally done under general anaesthesia, as a day case. Before planning surgery for an adult with good vision in both eyes, the surgeon may test with prisms how your brain would cope with the new alignment, to estimate the risk of double vision afterwards.
Four to five days in Istanbul
A typical programme for a stay of 4 to 5 days:
- Day 1: arrival, transfer to the hotel, consultation with the surgeon and detailed orthoptic measurements.
- Day 2: pre-anaesthetic assessment and any tests requested, then surgery on day 2 or day 3 depending on the plan. You go back to the hotel the same day with drops and written instructions.
- Day 3 or 4: check of the eye and the alignment, adjustment of sutures if they were used, and a review of your drop schedule.
- Day 5: flight home, once the surgeon has confirmed you are fit to fly.
No gas is placed in the eye during strabismus surgery, so flying a few days later is generally possible. The decision is still made by your surgeon after the check. A companion is helpful, especially on the day of the general anaesthetic.
Your quote, in writing
Esthappy organises the consultation, surgeon, anaesthesia and clinic fees, the hotel, transfers and an interpreter. The written quote should state exactly what is included, for example:
- the orthoptic assessment and pre-anaesthetic tests;
- whether one or both eyes, and how many muscles, are planned;
- the use of adjustable sutures, if relevant;
- post-operative checks in Istanbul and eye drops;
- hotel nights and transfers;
- how a longer stay or an additional procedure would be handled.
Healing week by week
First days: the eye is red, scratchy and watery, and moving it can feel sore. Simple pain relief is usually enough. Vision may be slightly blurred by drops or ointment.
First week: most people return to desk work after about a week. Avoid rubbing the eye, swimming, dusty places and eye make-up. Drops are used for a few weeks as prescribed.
Weeks 2 to 6: redness fades gradually, though a patch can persist for several weeks. The stitches dissolve on their own. Alignment can shift a little during this period as the tissues heal.
Months 2 to 3: the alignment is generally considered stable enough to judge the result and, if needed, to adjust glasses or prisms. In adults, double vision present just after surgery often settles as the brain adapts, but it can persist for a while and should be discussed beforehand.
What can go wrong, and how risk is reduced
The most common issue is not a complication in the usual sense but an imperfect result: under- or over-correction, or a deviation that drifts again over the years. A second operation may then be needed, and that possibility belongs in the conversation from the start. Other risks include:
- new or persistent double vision;
- persistent redness, a small cyst or a visible scar on the white of the eye;
- infection or a reaction to the drops, which is uncommon;
- rarely, a needle passing too deep through the wall of the eye, or a muscle slipping from its new position;
- a slight change in eyelid position after operations on vertical muscles;
- the usual risks of general anaesthesia.
Surgery does not restore sight in an amblyopic eye, and it does not remove the need for glasses where optical correction is part of the treatment. Risk is reduced by precise, repeated measurements, a clear plan on which muscles to operate, careful technique, prompt treatment of any infection and close follow-up in the first months.
What to ask the surgeon
- Which muscles will be operated on, on which eye, and why?
- What residual deviation would be considered an acceptable result?
- How likely is a second procedure in my case?
- What is my risk of double vision after surgery, and was it tested?
- Will adjustable sutures be used?
- Who will provide orthoptic follow-up near home?
Follow-up after you go home
Arrange an appointment with an ophthalmologist or orthoptist near home before you travel, ideally a few weeks after the operation and again at around three months. You can send photos of your eyes looking straight ahead and in different directions for remote follow-up, but measurements require an examination. Seek local care quickly for increasing pain, swelling, discharge, worsening vision or sudden new double vision.
Take home the operation note, which should state clearly which muscles were operated on and by how much, together with your pre-operative measurements and drop prescription. This information is decisive if a further procedure is ever considered.