Adult squint surgery realigns the eyes by repositioning one or more of the six extraocular muscles. It is a reconstructive day-case operation — not a cosmetic one — that abolishes double vision, restores the binocular field of single vision and corrects an abnormal head posture, with strong evidence for its psychosocial benefit too. Our consultant ophthalmologist and consultant orthoptist plan and deliver every case together, across recession, resection, adjustable-suture and botulinum-toxin techniques.
What adult squint surgery treats
A squint (strabismus) is a misalignment of the eyes — turning in (esotropia), out (exotropia), up or down. In adults it may be a childhood squint that has decompensated, a new squint from a cranial-nerve palsy, thyroid eye disease, trauma or previous eye surgery, or a long-standing visible deviation with real psychosocial impact. Surgery repositions the eye muscles so the eyes work together again.
It is offered when there is documented double vision, eye strain (asthenopia), an abnormal head posture, loss of the binocular field of single vision, or a visible squint with measured impact on quality of life. The Royal College of Ophthalmologists explicitly classes adult strabismus surgery as reconstructive rather than cosmetic, and most UK insurers cover it where functional impact is documented.
Treatment options
Your consultant and orthoptist choose the technique from a full orthoptic work-up — prism cover test in all gaze positions, Hess chart and binocular field of single vision. Most corrections combine more than one of these.
How the procedure works
Surgery is a day case, most often under general anaesthetic (or topical anaesthetic with sedation in selected adults). The skin of the eyelid is never cut. The surgeon opens the conjunctiva with a hidden fornix incision (Parks technique), isolates the target muscle on a hook, and either recesses it (moves the insertion 3–7 mm back to weaken it) or resects/plicates it (shortens it to strengthen it). A posterior fixation suture or vertical-rectus transposition is added for specific patterns such as cranial-nerve palsy.
When adjustable-suture surgery is used, the muscle is tied with a temporary slip-knot so the alignment can be refined in clinic 4–24 hours later under topical anaesthetic and orthoptic measurement. The conjunctiva is closed with absorbable sutures, and antibiotic-steroid drops are prescribed.
Living with double vision or a turned eye? A consultant-and-orthoptist assessment can map your options.
Book your assessmentRecovery & aftercare
Days 0–3 — Going home
A day-case discharge the same day. The eye feels gritty and waters for a few days; paracetamol or ibuprofen is usually enough. Most patients return to office work and screens the next day, and drive within 24–72 hours if DVLA standards are met.
Hours 4–24 — Adjustment (if used)
For adjustable-suture cases, the alignment is fine-tuned in clinic under topical anaesthetic and orthoptic measurement.
Weeks 1–2 — Settling
Antibiotic-steroid drops four times daily for two weeks. The eye is bloodshot from the conjunctival incision and fades over 1–2 weeks. Avoid swimming, contact sport and dusty environments for 2–4 weeks.
Months 1–3 — Orthoptic review
Day-1, week-1, month-1 and month-3 orthoptic reviews confirm the result. A small residual angle may be managed with a prism; 10–25% of adult primary cases need a planned second operation.
Cost of private adult squint surgery
London 2026 self-pay pricing is £4,500–7,500 per eye for a single-muscle correction, £5,500–8,500 per eye for a two-muscle correction and £6,500–10,500 all-inclusive for bilateral two-muscle surgery at CQC-registered London centres. Adjustable-suture surgery adds £500–1,200, re-operations carry a £500–1,500 surcharge for the extra theatre time, and botulinum toxin chemodenervation costs £850–1,500 per session. Fees include the consultant and orthoptic assessment, surgical planning, the day-case operation, consultant and anaesthetist fees, theatre and a 12-week orthoptic rehabilitation programme. See the price guide for the full breakdown.
Frequently asked questions
How much does private adult squint surgery cost in London in 2026?
London 2026 self-pay adult strabismus surgery costs £4,500–7,500 per eye for a single-muscle (recession or resection) correction, £5,500–8,500 per eye for a two-muscle correction, and £6,500–10,500 all-inclusive for bilateral two-muscle surgery at CQC-registered London centres. The fee covers the consultant and orthoptic assessment, full prism cover test, Hess chart, surgical planning, the day-case operation, the consultant and anaesthetist fees, the theatre and a structured 12-week orthoptic rehabilitation. Adjustable-suture surgery adds £500–1,200; botulinum toxin chemodenervation costs £850–1,500 per session.
Is adult squint surgery purely cosmetic?
No. The Royal College of Ophthalmologists, the British and Irish Orthoptic Society and validated AS-20 patient-reported outcome data all recognise adult strabismus surgery as a reconstructive procedure with documented functional benefits — abolishing double vision, restoring the binocular field of single vision and correcting an abnormal head posture — alongside a strong, evidence-based psychosocial benefit. Many UK insurers cover it when there is documented diplopia or significant impact, and the NHS commissions it under similar criteria.
Will I have a visible scar after squint surgery?
No. Modern adult strabismus surgery is performed through a fornix conjunctival incision (Parks technique) that heals invisibly, and the skin of the eyelid is not cut. The eye is bloodshot for 1–2 weeks from the conjunctival incision and subconjunctival haemorrhage; this fades and leaves no permanent visible scar.
What is adjustable-suture surgery and is it worth the extra cost?
Adjustable-suture surgery uses a temporary slip-knot at the muscle re-insertion site so the alignment can be fine-tuned 4–24 hours after surgery in clinic, under topical anaesthetic and orthoptic measurement. The Cochrane review (2018 update) found it gives better refined alignment in selected adults. The £500–1,200 upgrade is most worthwhile for unstable angles, re-operations, vertical squints and large angles, where every 1–2 mm of muscle position matters.
Could botulinum toxin be used instead of surgery?
Yes, in selected cases. An EMG-guided botulinum toxin injection temporarily weakens a rectus muscle for 8–16 weeks, costing £850–1,500 per session in London in 2026. It is useful as a diagnostic test of binocular potential before definitive surgery, as a treatment in unstable angles (early sixth-nerve palsy, evolving thyroid eye disease), as a primary option in some small to moderate-angle squints, and as an adjunct in selected paretic cases. The choice is made at consultation based on the type of squint.
What is the chance my squint will recur and need a second operation?
The realistic per-procedure motor success rate at 6 months is 70–85 percent for primary horizontal cases. About 10–25 percent of adult primary cases need a planned second operation, with the rate higher for large angles, vertical squints, previous surgery and thyroid-eye-disease-related strabismus. This is discussed honestly at consent and is one reason adjustable-suture surgery is offered for selected cases.