Yes, cross eyes (strabismus) can be fixed in adults. Surgery is the most common correction, with success rates between 60% and 83% depending on the type and severity of misalignment. Non-surgical options like prism glasses and muscle-relaxing injections also work well for many people, especially when surgery isn’t ideal.
Why Cross Eyes Develop or Return in Adults
Some adults have had strabismus since childhood, either untreated or partially corrected. Others develop it for the first time due to a medical condition. Thyroid eye disease is one of the more common causes: the immune system attacks the muscles around the eye, first causing swelling and then scarring that restricts movement. If an adult develops sudden eye misalignment along with a retracting or lagging eyelid, thyroid disease is a strong suspect.
Stroke is another frequent trigger. When blood flow to the brain is disrupted, the nerves controlling eye muscles can be damaged, leaving one or both eyes out of alignment. Head trauma, diabetes-related nerve damage, and neuromuscular conditions like myasthenia gravis round out the list of common causes. In some cases, a childhood surgery simply doesn’t hold, and the eyes gradually drift apart again over the years.
Prism Glasses: The Non-Surgical Fix
Prism lenses are specially ground glasses that bend light before it enters your eye, redirecting the image so both eyes receive it in the same spot. This eliminates double vision without changing the position of your eyes. Because alignment is a two-eye problem, the prism correction can be split between both lenses to keep each one thinner and lighter.
Your eye doctor will typically start with a stick-on prism applied to your existing glasses. You wear it for a trial period, including outside the clinic, to confirm the correction feels right during normal activities. If the temporary prism works well, the prescription can be ground permanently into a new pair of spectacles. Prisms are especially useful when the misalignment is small, when it fluctuates (as it does during recovery from a stroke or with thyroid eye disease), or when you want to avoid surgery altogether.
Muscle-Relaxing Injections
Botulinum toxin (commonly known by the brand name Botox) can be injected directly into the overactive eye muscle to temporarily paralyze it. Once that muscle relaxes, the opposing muscle pulls the eye into a straighter position. The injection takes effect within three to seven days and the paralysis generally lasts about three months, though this varies from person to person.
Injections work well as a standalone treatment for smaller deviations or as a bridge while doctors wait for an underlying condition to stabilize. They’re also used diagnostically: if the injection produces good alignment, it suggests surgery on that same muscle would likely succeed. The procedure is done in an office setting and doesn’t require general anesthesia, which makes it a practical choice for people who can’t safely undergo surgery.
Strabismus Surgery
Surgery remains the most definitive way to correct cross eyes in adults. The surgeon repositions one or more of the small muscles attached to the outside of the eyeball, either tightening a weak muscle or loosening a tight one to shift where the eye naturally rests. The procedure is performed under general anesthesia and typically takes about an hour, though this depends on how many muscles need adjustment.
One important refinement is the adjustable suture technique. Instead of permanently locking the muscle into place during surgery, the surgeon ties a knot that can be repositioned in the hours afterward while you’re awake and able to report what you see. This allows fine-tuning of the alignment before everything heals. Studies show that patients who receive adjustable sutures achieve the target alignment about 76% of the time, compared to 54% with standard fixed sutures.
Overall, surgery for horizontal strabismus (eyes turning inward or outward) has a success rate between 60% and 83%. Smaller deviations tend to do better: misalignments under 30 prism diopters have a recurrence rate of about 16%, while larger ones recur roughly 31% of the time. Some people do need a second surgery, but the majority see meaningful, lasting improvement after one procedure.
What Recovery Looks Like
You’ll need someone to drive you home and stay with you for the first 24 hours. Plan to rest and take it easy for up to a week, though some people need a few weeks before they feel fully back to normal. Your eyes will be red and sore, and you may notice some double vision while the muscles heal into their new positions.
Driving is off limits until your doctor clears you, which depends on how quickly your vision stabilizes. Swimming pools, saunas, and hot tubs are off the table for at least two weeks to reduce infection risk. Most people return to desk work within a week, but physically demanding jobs may require a longer break.
Surgical Risks
The most common issues after strabismus surgery are overcorrection and undercorrection, meaning the eyes end up slightly too far in the opposite direction or not quite straight enough. A “slipped muscle” can occur shortly after surgery when the repositioned muscle retracts behind its intended attachment point, causing a noticeable deviation and some limitation in eye movement. A related problem called stretched scar syndrome looks similar but shows up months later as the surgical scar gradually elongates.
Serious infection is rare. The most dangerous type, an internal eye infection called endophthalmitis, occurs in roughly 1 in 18,500 cases at most. Less severe infections like surface swelling or small abscesses are more common but treatable.
Insurance Coverage for Adults
A common concern is whether insurers will cover strabismus surgery for adults or dismiss it as cosmetic. Major insurers like Aetna classify the surgery as medically necessary when it aims to restore visual function. Qualifying criteria typically include double vision, loss of the ability to fuse images from both eyes, impaired peripheral vision from a significantly turned eye, or visual confusion where two different images overlap in the same space.
If you have strabismus but no functional vision problems, meaning your brain has fully adapted to ignoring one eye, insurers may consider the repair cosmetic and decline coverage. The practical takeaway: documenting your symptoms matters. If you experience double vision, difficulty driving, trouble with depth perception, or eye strain that interferes with work, make sure your doctor records these in detail before submitting for authorization.