Strabismus Surgery: How Eye Muscle Surgery Realigns the Eyes, Recovery and Risks
Updated: Nov 7
Written and medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026 · How we review
Quick Answer: What is strabismus surgery?
Strabismus surgery is an operation on the muscles that move the eye, used to treat misaligned eyes when other treatments haven't worked. A surgeon tightens or loosens one or more eye muscles so both eyes stay centered and work together. Most people go home the same day, and the eyes heal completely in two to three months. [1]
What the research says
Surgery lines up the eyes in roughly two out of three to three out of four cases. A review of 14 studies on common sideways (horizontal) strabismus found surgery achieved good alignment in 66%–77% of patients over about 2 to 6 years of follow-up. Botulinum toxin injections reached similar results (about 60%) in comparable studies, though some people needed more than one injection. (Binenbaum et al., Ophthalmology, 2021) [2]
Adjustable stitches may improve early success in children. A meta-analysis of 5 studies with 8,744 children found surgery with adjustable sutures had a 26% higher relative success rate than fixed sutures in the early period after surgery. Repeat-surgery rates were not significantly different between the two methods. (Liu et al., Survey of Ophthalmology, 2025) [3]
Quality of life improves after surgery. In a study of 239 adults, people with strabismus scored lower on daily-life and emotional well-being than people with other mild eye conditions. Two months after surgery, their scores improved significantly, though on average they did not fully reach the comparison group's level. (Takahashi et al., Japanese Journal of Ophthalmology, 2025) [4]
Key takeaways
Strabismus surgery changes the length or position of eye muscles to straighten the eyes.
It can treat any type of strabismus, including eyes that turn out, in, up or down.
The operation usually takes 30 minutes to 2 hours and you go home the same day.
You cannot drive yourself home, and usually not for a week or two afterward.
Red, sore or scratchy eyes are normal for a few weeks. Full healing takes 2–3 months.
Surgery does not fix blurry vision from refractive errors, so you will still need your glasses or contacts.
What is strabismus surgery?
Strabismus surgery is eye muscle surgery for misaligned eyes (strabismus). During surgery, the surgeon tightens or loosens the muscles that need it. This helps your eyes stay centered and work together better. [1]
It is usually offered when strabismus has not improved with other treatments.
Which eye conditions can strabismus surgery treat?
Eye muscle surgery can treat any kind of strabismus. Common types include:
Type | Direction the eye turns | Learn more |
Exotropia | Outward, toward the ear | |
Esotropia | Inward, toward the nose | |
Hypertropia | Upward | |
Hypotropia | Downward | — |
[1]
You may also need this surgery after a stroke. Learn more in our guide to thrombotic stroke.
Strabismus surgery can also improve nystagmus and other types of uncontrollable eye movements. [1]
What are the types of strabismus surgery?
The three main types of strabismus surgery are resection, plication and recession, and each one either tightens or loosens an eye muscle. [1]
Technique | What the surgeon does | Effect on the muscle |
Resection | Removes a small piece of the muscle | Tightens it |
Plication | Folds the muscle back over itself | Tightens it |
Recession | Moves the muscle's attachment point back | Loosens (weakens) it |
[1]
The right technique depends on which type of strabismus you have and why your eyes are out of alignment.
Your surgeon may change more than one muscle during the same operation.
How do you prepare for strabismus surgery?
You prepare for strabismus surgery by reviewing your health history and medicines with your care team, having a dilated eye exam, following fasting instructions and arranging a ride home. Expect your team to ask about: [1]
Your health history, including any previous eye surgeries
All medications and supplements you take, especially blood thinners
Any bad reaction to anesthesia in the past
You will also need a dilated eye exam to make sure surgery is safe for you.
Your team will tell you whether to stop any medications or supplements beforehand. They will also tell you when to stop eating and drinking. This is usually midnight the night before, but it can vary.
Plan your ride now. You will not be able to drive yourself home, and you will not be able to drive for a week or two after surgery. Arranging transport and help at home ahead of time makes recovery much easier.
What happens during strabismus surgery?
During strabismus surgery, you receive anesthesia while the surgeon makes a small cut in the clear tissue over the white of the eye, adjusts the eye muscle, and closes the eye with dissolvable stitches. [1]
Anesthesia
An anesthesiologist makes sure you do not feel pain. You will get one of two options:
General anesthesia, so you sleep through the procedure
Eye-numbing medicine plus light sedation
Step by step
The exact steps depend on how your muscles need to change. In general, the surgeon will:
Hold your eyelids open with a small device called an eye speculum.
Make a small cut in the clear tissue covering the white of the eye (conjunctiva) to reach the eye muscles.
Use a small hook to gently lift the muscle that needs surgery.
Cut, fold or move the muscle as planned.
Reattach the muscle and close the eye with dissolvable stitches.
Remove the speculum and place eye drops or ointment in the eye.
How long does strabismus surgery take?
Strabismus surgery usually takes between 30 minutes and two hours. Your surgeon can tell you what to expect for your specific case. [1]
What are the benefits and risks of strabismus surgery?
The main benefits of strabismus surgery are better teamwork between the eyes and a change in appearance, while the risks include infection, bleeding, scarring, double vision, a drooping eyelid and the eyes drifting out of alignment again. [1]
Benefits
Better teamwork between the eyes. Surgery can improve the way your eyes work together to create 3D vision (depth perception). This benefit is especially strong in children.
A change in appearance. Straighter eyes change how you look, and many people say this helps them feel more confident.
Risks
Like any surgery, strabismus surgery has some risks:
Risk | What to know |
Infection | Watch for fever, discharge, rising redness or eyelid swelling |
Bleeding | Part of the general risk of any surgery |
Scarring | Report any new growth of scar tissue or a discolored bump |
Double vision | Usually temporary |
Drooping eyelid | Usually temporary. See our droopy eyelid (ptosis) guide |
Recurrent misalignment | The eyes can drift out of alignment again over time |
[1]
If double vision worries you, our guide to diplopia (double vision) explains the causes and the warning signs that need urgent care.
What is recovery like after strabismus surgery?
Recovery after strabismus surgery starts with going home the same day, followed by a few days to two weeks of rest, a few weeks of red or scratchy eyes, and complete healing in two to three months. [1]
Going home
After surgery, your care team moves you to a recovery room. They help manage any pain and make sure you wake up from anesthesia without complications.
You go home the same day.
Your surgeon will prescribe eye drops or ointment, and your team will show you how to use them. You will also get a pain plan. Many people only need over-the-counter pain relievers. Ask your team which medicine is best and how often it is safe to take.
Recovery timeline
When | What to expect |
Surgery day | Home the same day; someone else drives. Start prescribed drops or ointment. |
First few days | Double vision is possible for a few days, and can last longer for some people. |
Days to 2 weeks | Rest period. No driving until your surgeon says it is safe (often a week or two). |
First 2 weeks | Stay out of swimming pools, saunas and hot tubs to prevent infection. |
First few weeks | Eyes may look red and feel sore or scratchy. |
Up to 6 weeks | Dissolvable stitches are absorbed by the body on their own. |
2–3 months | Eyes are completely healed. |
[1]
Once you recover, you should be able to return to all your usual activities.
Will I still need glasses after strabismus surgery?
Yes, if you needed glasses or contacts before surgery. The operation realigns your eyes, but it does not correct refractive errors, such as farsightedness (hyperopia), that cause blurry vision. [1]
Your glasses prescription probably will not change after surgery.
One exception: if you wore glasses with prisms before surgery, you usually will not need the prisms afterward.
When should you call your doctor after strabismus surgery?
Call your surgery care team right away after strabismus surgery if you notice worsening eye pain or vision, signs of infection, or your eye drifting in the opposite direction. Contact them if you notice:
Eye pain that gets worse, even after taking medicine
Vision that is getting worse
Your eye drifting significantly in the opposite direction
Signs of infection: fever, eye discharge, increasing redness in the white of the eye, or swelling and skin color change in the eyelid
A growth of scar tissue or a discolored bump on the eye
Any symptom that worries you
[1]
Conclusion
Feeling nervous before eye surgery is completely normal. But strabismus surgery can make a real difference. Correcting strabismus can help the eyes work together again, for some people for the first time ever.
Recovery takes a few weeks of care, with full healing at two to three months. Ask your surgery team every question you have, before and after the operation. They are there to help you understand each step.
Next step: Save or print this guide and bring it to your next eye appointment. If your child has misaligned eyes, read our guides to lazy eye (amblyopia) and binocular vision dysfunction to prepare your questions, and explore more eye-health guides on Rinnit.com.
FAQ
What is strabismus surgery?
It is an operation on the eye muscles that tightens or loosens them to correct misaligned eyes, so both eyes stay centered and work together.
Is strabismus surgery painful?
You do not feel pain during the operation because you receive general anesthesia or eye-numbing medicine with light sedation. Afterward, the eyes can feel sore or scratchy for a few weeks, and many people manage with over-the-counter pain relievers.
How long does strabismus surgery take?
Usually between 30 minutes and two hours, depending on how many muscles need adjusting.
Do I stay in the hospital overnight?
No. Most people go home the same day after a short stay in the recovery room.
How long is recovery after strabismus surgery?
Most people rest for a few days to a couple of weeks. Redness and scratchiness can last a few weeks, and the eyes heal completely in two to three months.
When can I drive after strabismus surgery?
Usually after a week or two, and only once your surgeon says it is safe.
Is double vision after strabismus surgery normal?
Yes, it is common for a few days and is usually temporary. It can last longer for some people. Tell your surgeon if it worsens or does not improve.
When can I swim after strabismus surgery?
Avoid swimming pools, saunas and hot tubs for two weeks after surgery to lower the risk of infection.
Do the stitches need to be removed?
No. The stitches dissolve on their own and are safely absorbed by the body, which can take up to six weeks.
Can strabismus come back after surgery?
Yes. The eyes falling out of alignment again (recurrent misalignment) is one of the known risks of the surgery.
Will I still need glasses after strabismus surgery?
Yes, if you wore them before. Surgery straightens the eyes but does not fix refractive errors. If you used prism glasses, you usually will not need the prisms afterward.
Can adults have strabismus surgery?
Yes. It can treat any type of strabismus, and people may need it later in life, for example after a stroke. The benefits for 3D vision are often strongest in children.
Related reading on Rinnit
Exotropia: Why an Eye Turns Outward and What Treatment Options Look Like
Esotropia (Crossed Eyes): Causes, Types, Symptoms, and Treatment
Hypertropia: A Comprehensive Guide to Symptoms, Causes, and Clinical Management
Lazy Eye (Amblyopia): Symptoms, Causes, Treatment & Complete Guide
Diplopia (Double Vision): What Causes It, How It's Classified, and When It's an Emergency
External resources: Strabismus Surgery, Horizontal — EyeWiki (American Academy of Ophthalmology) · American Association for Pediatric Ophthalmology and Strabismus
Depth Perception Test (Stereopsis Test): Types, How It's Done and What Results Mean explains the test that checks how well the eyes work together to judge depth.
Related Reading
Hirschberg Test (Corneal Light Reflex): How Eye Alignment Is Checked explains the light test used to check eye alignment.
References
Cleveland Clinic. Strabismus Surgery: Details, Results & Recovery. Cleveland Clinic. Last updated April 17, 2026. https://my.clevelandclinic.org/health/treatments/24488-strabismus-surgery
Binenbaum G, Chang MY, Heidary G, et al. Botulinum Toxin Injection for the Treatment of Strabismus: A Report by the American Academy of Ophthalmology. Ophthalmology. 2021;128(12):1766-1776. PMID 34176652. https://doi.org/10.1016/j.ophtha.2021.05.009
Liu C, Yan R, Jiang J. Adjustable suture versus nonadjustable suture surgery for childhood strabismus: A meta-analysis. Surv Ophthalmol. 2025;70(5):859-867. PMID 40164392. https://doi.org/10.1016/j.survophthal.2025.03.007
Takahashi S, Goseki T, Noda S, et al. Reliability and validity of pre- and post-operative health-related quality of life in strabismus patients using the Japanese version of the adult strabismus questionnaire (AS-20). Jpn J Ophthalmol. 2025;69(2):159-165. PMID 39918703. https://doi.org/10.1007/s10384-025-01162-x
Kumari N, Amitava AK, Ashraf M, et al. Prognostic preoperative factors for successful outcome of surgery in horizontal strabismus. Oman J Ophthalmol. 2017;10(2):76-80. PMID 28757690. https://doi.org/10.4103/ojo.OJO_133_2016
American Academy of Ophthalmology. Strabismus Surgery, Horizontal. EyeWiki. Last updated October 7, 2026. https://eyewiki.aao.org/Strabismus_Surgery,_Horizontal
American Association for Pediatric Ophthalmology and Strabismus. Strabismus Surgery. AAPOS Glossary. Last updated January 2022. https://aapos.org/glossary/strabismus-surgery
Medical disclaimer
This article is for general education only and is not a substitute for professional medical advice, diagnosis or treatment. Always talk with your eye doctor or surgeon about your own situation before making decisions about surgery.
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