Ophthalmology Outcomes
Adult Strabismus
The Adult Strabismus Service at Mass Eye and Ear provides comprehensive diagnoses and treatments for adults with strabismus. Treatment can include prism therapy, Botox® injections, or strabismus surgery. The service is one of the few in the country that performs strabismus surgery specifically in adults and is distinct from the Mass Eye and Ear Pediatric Ophthalmology and Strabismus Service, which is affiliated with Boston Children’s Hospital.
Learn more about strabismus care at Mass Eye and EarPreoperative Symptoms in Adult Strabismus Surgery Patients
During the 2022 calendar year, the Mass Eye and Ear Adult Strabismus Service performed strabismus surgery on 162 patients. The majority of patients (85.8%, or 139/162 patients) had diplopia pre-operatively. Diplopia was also a common pre-operative symptom in prior calendar years, as shown above.
Underlying Etiologies Associated with Adult Strabismus Surgery
Of the 162 strabismus surgery cases performed in calendar year 2022, the most common etiology was idiopathic or congenital strabismus (29.6%, or 48 patients). Sensory exotropia was the second most common cause (22.2%, or 36 patients). Other etiologies included sagging eye syndrome (11.7%, or 19 patients), thyroid eye disease (11.1%, or 18 patients), sixth nerve palsy (8.0%, or 13 patients), fourth nerve palsy (4.9%, or 8 patients), traumatic and post-surgical strabismus (4.9%, or 8 patients), third nerve palsy (3.1%, or 5 patients), and skew deviation (1.9%, or 3 patients). The remaining etiologies (2.4%, or 4 patients) were stroke, Duane syndrome, multiple sclerosis, and ocular myasthenia gravis.
Success Rates for Adult Strabismus Surgery at Six Months Follow-up
In calendar year 2022, 139 of 162 patients (85.8%) had diplopia prior to their surgeries. Of these 139 patients, 107 had between one- and six-months follow-up data available, and therefore, were included in the above analysis. Postoperatively, 73 of 107 patients (68.2%) were without diplopia in the primary position or had a deviation of less than six prism diopters after a single surgery that did not require prism glasses at their six-month follow-up appointment. Thirteen of 107 patients (12.1%) who had diplopia after surgery were without diplopia in the primary position with prism glasses. Eight of 107 patients (7.5%) required a second surgery that was performed within six months. The remaining 13 of 107 patients (12.1%) had persistent diplopia at their follow-up appointment closest to six months.
Of the 162 patients who had strabismus surgery, 161 patients (99.4%) had the adjustable suture technique, and one patient (0.6%) had a non-adjustable procedure. Of the 161 patients who underwent an adjustable procedure, 33 patients (20.5%) needed an adjustment in the immediate post-operative period, two to three hours following surgery.
There were zero cases that were complicated by scleral perforation, and zero cases developed an infection within 30 days of surgery. These results are the same as in calendar years 2012 to 2021.
