Does wearing an eye patch help fix eye misalignment?

Simply put, no it does not.

This is a common misconception. I frequently see patients who come for a second opinion or because they're new to the area, and their parents tell me something like, "He patched for a few months, but it didn't help, the eye was still crossed in." Patching doesn't help straighten the eyes; it's done to help the non-patched eye develop better vision, but it almost never also results in better eye alignment.

This child has a fun eye patch on his left eye to help his right eye develop better vision. Patching improves eyesight, not eye misalignment.

Patching treats amblyopia, not strabismus (eye misalignment). Amblyopia occurs when a child's vision doesn't develop normally, and starts to "fall behind." It usually affects just one eye, but rarely may affect both. A child isn't born with the ability to see 20/20; this develops over time. If something is interfering with this process -- for example, eye misalignment -- then the brain often "picks" an eye and develops better vision with that eye, at the expense of the other eye. An analogy I often use is that amblyopia is like having one strong arm and one weak arm: naturally, you want to do everything with your stronger arm, and as you do that, the strong gets stronger and the weak gets weaker.

Patching the better-seeing eye allows the child to rely on their worse-seeing eye, and doing this helps them develop better vision with that eye, sort of like putting the "strong arm" in a sling and doing everything with your weaker arm. This process works best, and quickest, the younger a child is. By age 8-9 years old, a child's visual development is over, and patching is much less likely to be effective.

This can be confusing, because for a child with a misaligned eye that also doesn't see well, while they are wearing their patch on the other eye, the "bad eye" will be straight! This doesn't mean the eye misalignment is better, it just means the child is using that eye. Once the patch comes off, you'll see the eye misalignment again.

As patching continues, a child's vision in the non-patched eye should improve -- they should see better and better on the eye chart (note: preverbal children can certainly also develop amblyopia, and their vision is measured in different ways). However, if they have strabismus, the eye misalignment typically doesn't change much. That doesn't mean patching hasn't worked, as you now know!

For a child with both amblyopia and strabismus, the first step is treating the amblyopia, with some combination of glasses, patching, and/or eyedrops. Once the amblyopia has been treated successfully/maximally, the next step is treating the strabismus, with glasses and/or eye muscle surgery.

To learn more about amblyopia, check out this video from Dr. Weed.

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Answers to common questions about strabismus (eye muscle) surgery

Here is a short video with the answers to the following eight questions that patients and parents most commonly ask about strabismus surgery.

1. What are you actually doing in eye muscle surgery?

2. Is eye muscle surgery done under general anesthesia?

3. What’s the recovery like after eye muscle surgery?

4. Will I need to wear a patch after strabismus surgery?

5. What is the success rate of strabismus surgery?

6. Is strabismus surgery covered by insurance?

7. Do you have to take the eyeball out during strabismus surgery?

8. How old is too old, or too young, to have strabismus surgery?

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Can crossed eyes or a wandering "lazy" eye be fixed?

In a word, yes!

People with strabismus -- the medical term for eye misalignment -- whether they have an eye that turns in (esotropia) or wanders out (exotropia), or an eye that goes up (hypertropia), don't have to just "live with it." In almost all cases, they can be treated successfully. The most common treatment options are glasses and eye muscle surgery.

This child has esotropia.

Patients frequently come to see me for strabismus and report having been told by prior physicians, sometimes even eye doctors, that "nothing could be done." I often hear comments after corrective surgery like, "If I had known this could have been fixed, I wouldn't have lived with it all these years!"

Strabismus often causes double vision, especially in adults, and people who haven't lived with double vision rarely grasp how unpleasant, frustrating, and debilitating this condition can be. Even when eye misalignment doesn't cause double vision, in our society, there is an unfortunate but real stigma associated with strabismus, and patients often suffer socially. Children and adults with strabismus are often, incorrectly and unfairly, perceived as less intelligent. Fortunately, as mentioned above, this doesn't need to be the case.

There is no "age limit" to strabismus surgery. This procedure is relatively quick, typically lasting about 40 minutes, and is performed under general anesthesia on an outpatient basis, with patients going home the same day.

Because eye misalignment is often associated with poor vision in childhood, and rarely with an underlying medical problem, if your child's eyes aren't straight, be sure to schedule a visit to see an eye doctor.

To learn more about health insurance coverage for eye muscle surgery, read this.

If you would like to learn about what you might expect in the recovery period after strabismus surgery, click here.

Finally, here is some additional information about reasons why you might consider having strabismus surgery.

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What's the recovery like after strabismus surgery?

Strabismus surgery, or eye muscle surgery to realign the eyes, is done on an outpatient basis, so patients are able to go home an hour or two after the surgery is done.

Because strabismus surgery is done under general anesthesia, patients will be fairly groggy afterward, and must have someone with them to drive them home.

There are a few things that are normal symptoms to have after surgery, including:

• Red eyes, typically lasting a week or two

• Eye pain, which is usually mild and improves within a few days

• Blurry vision

• Eye discharge, which may be yellow, red, or even light green sometimes!

• Double vision, which is not unusual during the first few weeks of the healing process, especially for adults

Symptoms that are not expected, and should prompt a phone call, include:

• Severe eye pain not responsive to ice packs or oral pain medication

• Swelling of the eyelids that is so severe the patient can't open their eyes

• Worsening redness

• Vision that continues to get worse

Most patients do very well after strabismus surgery, and need only a few days off from school or work. Plan on seeing me in the office a week after your surgery to check to make sure your eyes are healing normally, and then again six weeks later to assess the outcome of the surgery.

How do you measure strabismus (eye misalignment)?

Strabismus can affect both children and adults, and occurs when the eyes are not aligned. As you may know, the misalignment can be very small, very large, or anywhere in between. By using prisms -- just like the prisms you learned about in science class -- we can measure the amount of misalignment, which helps to determine what is causing the strabismus, whether it's getting better over time, and how best to treat it.

Prisms come in different sizes, allowing us to measure eye misalignment.

Using prisms to measure any strabismus detected on the eye exam is a critical component of the eye exam. Although the prisms are held near the eyes, they don't hurt in any way, and it's possible to get useful measurements with prisms for the majority of patients. As your child grows, our ability to measure their eye misalignment will likely get even better, too.

When is strabismus surgery needed?

For patients both young and old with eye misalignment, or strabismus, surgery can often be performed.

Some reasons to perform strabismus surgery include the following:

This child has a dissociated vertical deviation (DVD), a type of strabismus in which one eye will periodically drift upward, while the other eye stays put. Surgery can be curative.

1. To help the eyes work together and promote the development of good binocular vision, or depth perception. This is most important for young children, during the critical period of visual development that occurs in the first few years of life.
2. To eliminate double vision. This is usually more of a concern for adults, as children with strabismus typically ignore the second image and don't have double vision.
3. To minimize any abnormal head turn or tilt that a patient might prefer, either consciously or subconsciously, to try to minimize their strabismus. These abnormal head postures, if present chronically, can become physically and socially disabling.
4. To improve the ability to interact with others. There is an unfair stigma that often exists in society with regard to people with eye misalignment. I love helping people get their eyes straight, not only because it helps their vision, but also because it helps them gain confidence in their social interactions.

Is strabismus surgery covered by insurance?

Patients commonly wonder if eye muscle surgery to realign the eyes and fix strabismus is covered by insurance.

In a word, yes!

Virtually all health insurances, both private and state-sponsored, cover strabismus surgery, as it is reconstructive, not cosmetic. Our office will be sure to verify this with your insurance provider prior to the surgery date. If there will be any anticipated out-of-pocket costs, we will let you know beforehand.