Crossed eyes in adults can also be corrected

Since she was a baby, Carleen Trautz's left eye turned outward, rather than looking straight ahead, and it made her life miserable.

Kids teased her mercilessly. When she talked to people, they couldn't tell which of her eyes was looking at them. As an adult, Trautz was self conscious, lacked self esteem and always tried to hide the left side of her face.

But since Loyola University Health System ophthalmologist Dr. James McDonnell performed surgery to repair the defect, Trautz's eye has been in a normal position.

"It turned my life around," said Trautz, 48.

McDonnell has performed thousands of corrective surgeries in children and adults whose eyes are misaligned for various reasons. But many adults who have this defect, called strabismus, wrongly believe there's no treatment.

When Trautz was a child, she was told to do eye exercises, which didn't help. "No one told me it could be repaired," she said. It wasn't until Trautz took her mother to see McDonnell for an unrelated eye surgery that she learned from McDonnell that her strabismus could be corrected.

Strabismus "is emotionally debilitating," Trautz said. "After the surgery, my self confidence expanded by leaps and bounds. I never dated before. Now, I'm engaged."

She underwent the surgery 11 years ago, and the condition remains completely repaired, she said.

Patients are given many reasons why they shouldn't get treatment: Nothing could be done after a certain age; they would outgrow the problem; they would need another surgery or if they had undergone a previous surgery nothing further could be done. Some patients are told that insurance won't cover the procedure.
"None of these things are true," McDonnell said. "This type of misinformation can come from friends, family doctors, and even ophthalmologists and optometrists."

McDonnell has performed the procedure on patients ranging in age from infancy to past 90, with excellent outcomes. In addition to restoring normal appearance, the surgery also can improve depth perception and eliminate double vision or eye strain.

About half of the strabismus surgeries McDonnell performs are on adults. To correct the misalignments, he operates on the muscles that control the movement of the eyes. He uses a different technique than the techniques typically used on children. In some patients he uses an adjustable suture technique that allows him to fine-tune the eyes into the exact alignment.

"Our goal is to restore patients' eyes to a normal functional alignment so they can use their eyes together to the best of their ability," McDonnell said. "We want them to be able to look anyone directly in the eye and feel confident that their eyes appear normal. When you can't look someone in the eye, it affects your fundamental ability to communicate. It can be very debilitating."

Risks of the outpatient surgery, which are very rare, include infection and detached retina.

Many adult patients have had the condition all their lives. Others develop strabismus as a result of such conditions as stroke, tumor or brain injury. Studies show these patients think about their eyes almost every hour of every day.

"You become very self conscious about it," said William Stofan, 59, who underwent surgery on his right eye, which drifted to the right. "I would not even think about asking a woman for a date."

Stofan said not being able to make eye contact was horrible. "When people looked at me, I felt like a freak," he said.

Stofan said he has had strabismus for years, but the condition became more noticeable about two years ago. He would make jokes about it, "but it got to the point where it wasn't funny anymore."

The surgery caused minimal pain -- Stofan took just one Advil the next day. "I'm back to being the old me," he said. "My confidence is stronger than it ever was."
McDonnell said the surgery is very rewarding. "There are always tears of joy and relief from the patient and from me," he said. "I'm like the town crier, but it's just so wonderful and humbling to see each person after surgery. It's a shame when patients wait years to correct something we can address in about 1 hour."

Some adult patients can be treated with Botox, which temporarily weakens muscles. The drug weakens the pull of a strong muscle, allowing the weaker muscle to gain strength. When the drug wears off in about two months, proper muscle balance and eye alignment often are restored, McDonnell said.
McDonnell is a professor in the Department of Ophthalmology at Loyola University Chicago Stritch School of Medicine.