Can Cataract Surgery Cause Strabismus in Adults?

It doesn’t matter how old you are, discovering you have cataracts can be scary and nerve-racking, – especially if you are already noticing problems with your vision. Furthermore, despite its routine nature, the prospect of undergoing Cataract Surgery can be a daunting one, particularly if you are unfamiliar with the procedure. It is recommended to learn as much as possible before heading into surgery because, as we all know, knowledge dispels fear.

Aside from knowing about the procedure itself, you may be concerned about the potential side effects of Cataract Surgery. For example: Can Cataract Surgery cause strabismus in adults?

We’re going to be taking a look at the current evidence of post-Cataract Surgery and strabismus. But first, let’s explain what strabismus actually is.

Strabismus (Misaligned Eyes)

Strabismus is an eye disorder that affects the alignment of the eyes – that is to say, both eyes do not line up in the same direction. It may also be referred to as “crossed eyes” or a “squint”. Strabismus occurs when the muscles that control the eye do not work together, causing each eye to focus on different objects.

This can result in two different images being sent to the brain. If this is the case, then the brain can learn to disregard the information sent by the weaker eye, causing a loss of some vision. This is known as amblyopia or “lazy eye”.

Strabismus can also occur with or without diplopia (double vision) with both forms estimated to affect around 4% of the UK adult population.

Causes of Strabismus

In most children with strabismus, the cause is unknown and in more than half of these cases, strabismus is present at or shortly after birth. This is known as congenital strabismus. However, the development of strabismus in childhood can also be linked to conditions such as cerebral palsy, Apert syndrome, Noonan Syndrome, and congenital rubella.

When strabismus develops in adults, it may be caused by conditions including botulism, diabetes, and Graves disease, as well as traumatic eye injury/diseases, stroke, and traumatic brain injury.

So, what about the link between Cataract Surgery and strabismus?

Strabismus and Cataract Surgery

Cataract Surgery is an extremely common procedure that involves the removal of the eye’s natural clouded lens and the implantation of an artificial intraocular lens (IOL). The procedure is generally associated with excellent visual outcomes; however, despite high success rates, complications can occur.

Diplopia and Strabismus

Diplopia is one such complication that may occur due to several factors following an otherwise uneventful Cataract procedure. The occurrence of monocular diplopia following Cataract Surgery can be linked to intraocular lens decentration, uncorrected ametropia (refractive error), or corneal epithelial irregularities.

Transient binocular diplopia is a more common occurrence following Cataract Surgery, however, it often spontaneously resolves within a matter of days or weeks. Such cases of diplopia can be linked to pre-existing fusible sensory strabismus, a prolonged local anaesthetic effect and operative trauma to the orbital soft tissue.

How Common is it?

A 2008 study found that up to 3% of US Cataract Surgery patients experience diplopia following the procedure with the leading cause being deterioration of pre-existing strabismus (34%). Furthermore, current findings suggest that post-operative visual blur can deteriorate previously well-controlled and asymptomatic strabismus – this is believed to be the main cause of strabismus following ocular surgeries.

While the development (or deterioration) of strabismus is rare following Cataract Surgery, it can represent a significant side effect. Treatment should therefore take into account any prior strabismus history, strabismus surgery or other treatment.

Treating Post-Cataract Surgery Strabismus

The treatment of post-cataract surgery strabismus can depend on the exact cause of the condition. However, in most patients, symptoms can be managed with prism glasses. In cases where prism glasses are ineffective, strabismus surgery may be considered. Still, prevention is the most important consideration and a thorough history and motility exam should be performed in all patients.

If you are concerned about the risk of strabismus following Laser Eye Surgery, one of our friendly clinic coordinators is on hand to help. Get in touch with London Vision Clinic or Book a Consultation today.