ENParents often spot a squint in family photos: one of their child’s eyes drifts to the side. In adults it can begin suddenly, with double vision.
Strabismus treatment in Germany is led by strabologists, ophthalmologists specialising in eye alignment and teamwork between the eyes, alongside orthoptists, who measure the squint. Below: the condition, its examination, treatment with and without surgery, and how the trip is organised; for an overview, see ophthalmology in Germany.
What strabismus is and why it should not wait
Strabismus means the eyes point at different spots, and it should not wait: in a child it holds back vision, in an adult it can signal disease. One eye may turn towards the nose (esotropia), outwards (exotropia), up or down. The squint can be constant or intermittent, visible or latent, showing only with tiredness.
In children the main risk is amblyopia, or «lazy eye»: the brain ignores the squinting eye’s image, and its vision falls behind. Untreated in childhood, while the visual system matures, the loss can be permanent. In adults, a sudden squint with double vision first requires ruling out a neurological cause, such as nerve damage or a blood supply problem, with a neurologist.
Examination by a strabismus specialist
An examination by a strabismus specialist shows the type of squint and whether the eyes work as a team, which is called binocular vision. The angle is measured with prisms, covering each eye in turn; eye movements and the back of the eye are checked too. Children’s prescriptions are measured after drops that briefly relax focusing (cycloplegia), or hidden long-sightedness may be missed.
Bring medical reports, recent glasses prescriptions, details of any patching and photos of the child at different ages; for adults, MRI results if available. The plan is made only after an in-person examination: a description from home cannot replace measurements.
Treatment without surgery: glasses, patching, prisms
Without surgery, strabismus is treated with glasses, patching and prisms, and for some children this is enough. An inward squint is often caused by uncorrected long-sightedness: as the child strains to focus, the eyes turn in. Correctly fitted glasses reduce this deviation and sometimes remove it while worn.
Patching (occlusion) covers the better eye for part of the day so that the «lazy» eye has to work. The doctor sets the schedule and adjusts it after regular checks. Much depends on the family, as missed hours reduce the effect. A Cochrane systematic review notes that amblyopia can be treated successfully, especially in younger children, but adherence often limits results.
Prism glasses often help adults with double vision: the prism bends light so the image falls on the right spot of the retina. They are fitted after measurements. In selected cases, botulinum toxin is injected to weaken an eye muscle temporarily, if the strabologist advises it.
Eye muscle surgery
Eye muscle surgery is offered when glasses and patching are not enough: the angle stays large, double vision disrupts daily life, or the head is held tilted to avoid it. A muscle is weakened by moving its attachment back or strengthened by shortening it. The eye is not taken out of its socket, a common fear: the muscles lie on the eyeball’s surface and are reached through a small cut in the conjunctiva, the eye’s thin outer membrane.
Children have general anaesthesia; adults usually too, though local anaesthesia is used in selected cases. Afterwards the eye is red and feels gritty, drops are prescribed and follow-up visits are booked in advance. A second operation is sometimes needed, as the surgeon explains at the consultation.
Surgery straightens the eyes but does not treat amblyopia, so glasses and patching often continue. How straight the eyes end up depends on the type of squint, and the surgeon discusses expectations beforehand.
Where strabismus is treated in Germany
In Germany, strabismus is treated at eye hospitals with dedicated strabologists. At University Eye Hospital Tübingen, the section for strabismus treatment and the lid and orbit centre have been headed since 2005 by Prof. Dorothea Besch, whose work covers squint, double vision, amblyopia and eye muscle surgery. The Herzog Carl Theodor Eye Clinic in Munich was founded in 1895; its strabismus and paediatric eye specialist is Dr. Ernst Höfling, a Belegarzt (a doctor in private practice who operates there). He diagnoses latent squint, prescribes prism glasses and operates on eye muscles for strabismus and nystagmus (involuntary eye shaking).
At the Eye Centre of the University Hospital Cologne, Dr. Julia Fricke co-leads the strabismus and neuro-ophthalmology unit. At the University Eye Hospital Heidelberg, Dr. Flemming Beisse is deputy head of the section for strabismus treatment and neuro-ophthalmology. Choose by age and type of squint, not reputation: a child with amblyopia needs a team used to small children, an adult with sudden double vision a unit with neuro-ophthalmology.
Frequently asked questions
Does strabismus in a child go away on its own?
You should not count on it. If strabismus has caused amblyopia, the lazy eye’s vision usually worsens without treatment in early childhood, and the later treatment starts, the more often it fails. See an ophthalmologist straight away instead of waiting for the child to «grow out of it».
Is strabismus surgery dangerous?
It carries risks like any operation, but serious complications are rare: losing sight is unlikely, and bleeding or inflammation are uncommon. Double vision may appear and usually fades after a few days; occasionally a second operation or temporary prisms are needed. The surgeon explains the risks before consent is signed.
How long does strabismus treatment in Germany take?
It depends on what is needed. An examination with a glasses or patching plan needs a shorter trip. Surgery adds an anaesthetist’s consultation, the operation and first follow-up visits, as day surgery or with a short hospital stay. The clinic proposes a day-by-day plan after reviewing the documents.
How AlenMed organises strabismus treatment
AlenMed translates medical reports and glasses prescriptions, forwards them to the strabologist at a partner clinic, proposes examination dates and arranges the trip. If surgery is needed, the clinic prepares a cost estimate (Kostenvoranschlag); for orientation, see eye surgery prices.
A child travels with an accompanying parent. AlenMed fits anaesthesia and follow-up visits into one trip, and the family leaves with a patching and glasses plan. An interpreter attends appointments; AlenMed helps with the visa invitation. AlenMed’s office is in Munich; partner clinics are all over Germany. See also treatment for children in Germany.
This material is for information only and is not an offer. The method and extent of treatment are decided by the strabologist at an in-person appointment.
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