Small Deviations: Vertical, Horizontal, and Combined

Introduction and Purpose Symptomatic, small-angle strabismus is largely an acquired problem of adults that has previously been managed with prism spectacles. This paper will explore surgical options that are becoming increasingly popular. Methods The special issues that confound surgical treatment of small-angle strabismus are considered. Surgical procedures described in the literature and in the author's experience that address these issues are reviewed. Results Several recently described surgical techniques show promise for treatment of small-angle strabismus in adults. Their use is illustrated in a case report. Review of the author's practice shows a rapid increase in surgery for small-angle strabismus. Conclusions Surgical strategies for small deviations are increasingly important to meet the spectacle-free expectations of our adult patients.