Strabismus Surgery in Turkey: Cost, Recovery & Results for Lazy Eye Correction

What causes strabismus?

Strabismus can be associated with visual defects or serious eye diseases. The main causes of these defects include:

• Genetic factors.
• Ocular disorders such as cataracts and ptosis.
• Optical refractive errors.
• Paralysis of one of the eye muscles.

In children, strabismus may be caused by incorrect refractive errors or hyperopia, resulting in convergent strabismus.

Reduced central vision in one eye (amblyopia or lazy eye) is another common cause of strabismus, usually resulting in divergent strabismus. In addition, strabismus may be present from birth and is known as congenital strabismus, but is not associated with other ocular changes.

What are the types of strabismus?

Strabismus is described by the direction in which the eye turns:

• Esotropia (convergent strabismus): the eye turns inward. In children it is often linked to farsightedness (accommodative esotropia).
• Exotropia (divergent strabismus): the eye turns outward. It can be intermittent, appearing mostly when the person is tired or looking at distant objects.
• Vertical strabismus: the eye turns upward or downward.

It can also be classified by cause. Congenital strabismus is present from birth, while paralytic or restrictive strabismus comes from a problem with a muscle or nerve, for example after a stroke, an injury or thyroid eye disease. Each type has its own treatment considerations, and the ophthalmologist decides after a full examination.

How is strabismus diagnosed?

Diagnosis starts with a full eye examination by an ophthalmologist, ideally one who specializes in strabismus (and, for a child, in pediatric ophthalmology). The exam usually includes:

• Visual acuity and refraction: checking how well each eye sees and whether glasses are needed. In children this is often done with dilating drops.
• Cover test: the doctor covers each eye in turn and watches how the other one moves, which reveals the misalignment.
• Eye movement and binocular vision tests: to see whether the muscles move the eyes normally and whether the eyes work together.
• Measurement of the deviation: often with prisms, to decide whether glasses, prisms or surgery are the right option.
• Examination of the inside of the eye: to rule out another cause for reduced vision.

In children the doctor also checks for amblyopia (lazy eye),because it needs treatment alongside the alignment. The results decide the plan and the timing of any surgery.

How does strabismus affect vision?

Strabismus, a misalignment of the eyes, disrupts the normal coordination of binocular vision, so that the two eyes send different images to the brain.

Double vision and image suppression

The misaligned eye looks at a different object than the other eye. This can cause double vision (diplopia). In children, the brain often suppresses the image from the misaligned eye to avoid it.

Amblyopia: reduced vision in one eye

If a child's brain keeps suppressing the image from one eye, that eye may not develop normal visual acuity, even if its structure is normal. This is amblyopia ("lazy eye"). It can become permanent if it is not treated at a young age, which is why early assessment matters.

Loss of depth perception

Binocular vision is needed for depth perception. Strabismus can make it harder to judge distances and to move in space.

Head posture

Some people tilt or turn the head to compensate for the misalignment, which can cause neck pain.

What are the treatment options for strabismus in Turkey?

The treatment of strabismus in adults and children aims to improve alignment and binocular vision. The ophthalmologist chooses according to the type, the cause and the age.

Optical correction

• Eyeglasses: prescription glasses are often the first step. They correct refractive errors (nearsightedness, farsightedness, astigmatism) and can improve the alignment in some types of strabismus, especially accommodative esotropia in children.
• Contact lenses: in some cases, contact lenses may be an alternative to glasses, according to age and eye condition.
• Prisms: prism lenses can reduce double vision in selected cases.

Other non-surgical treatments

Patching or other treatment of amblyopia, vision (orthoptic) exercises and botulinum toxin injections into an eye muscle are also used in selected cases.

Surgery

The goal of strabismus surgery is to realign the eyes by weakening, strengthening or repositioning eye muscles. It is usually performed under general anaesthesia in children and, in some adults, under local anaesthesia with sedation, sometimes with adjustable sutures. The surgeon chooses the technique for each case.

How is strabismus treated in adults?

Adult strabismus may be due to untreated childhood strabismus, a recurrence, an eye muscle problem (such as paralysis after a stroke or an injury) or a thyroid eye disease.

Treatment is similar to that for children and may include glasses, prisms, botulinum toxin injections and surgery. An adult who suddenly develops double vision should see a doctor without delay, because the cause can be a neurological problem.

Double vision can occur after surgery in adults and may need prism glasses or orthoptic exercises.

How is strabismus treated in children?

Early assessment helps protect a child's vision and prevent amblyopia. In infantile (congenital) esotropia, surgery is usually planned between about 6 months and 2 years of age, and the surgeon decides the timing after a full examination.

Pediatric strabismus surgery can bring several benefits:

• Improved alignment and, in some children, binocular vision and depth perception
• Reduced eye strain and double vision
• Improved appearance, which can help the child's social confidence

Choose an ophthalmologist who is a pediatric strabismus specialist, and ask what the plan is if amblyopia is present.