HIGHLIGHTED FINDINGS & RECOMMENDATIONS FOR CARE

Document Overview

Design and created by Guideline Central in participation with the American Academy of Ophthalmology.

Adult Strabismus

American Academy of Ophthalmology

Publication Date: Feb 12, 2024

Page Last Updated: May 5, 2026

Recommendation Grading

Study Ratings¹
I++	High-quality meta-analyses, systematic reviews of randomized controlled trials (RCTs), or RCTs with a very low risk of bias
I+	Well-conducted meta-analyses, systematic reviews of RCTs, or RCTs with a low risk of bias
I-	Meta-analyses, systematic reviews of RCTs, or RCTs with a high risk of bias
II++	High-quality systematic reviews of case-control or cohort studies High-quality case-control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is casual
II+	Well-conducted case-control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is casual
II-	Case-control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not casual
III	Nonanalytic studies (e.g., case reports, case series
Evidence Ratings²
G - Good quality	Further research is very unlikely to change our confidence in the estimate of effect
M - Moderate quality	Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate
In - Insufficient quality	Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate Any estimate of effect is very uncertain
Recommendation Ratings³
S - Strong recommendation	Used when the desirable effects on an intervention clearly outweigh the undesirable effects or clearly do not
D - Discretionary recommendation	Used when the trade-offs are less certain—either because of low-quality evidence or because evidence suggests that desirable and undesirable effects are closely balanced

1. To rate individual studies, a scale based on Scottish Intercollegiate Guideline Network (SIGN) is used.
2. The body of evidence quality ratings is defined by Grading of Recommendations Assessment, Development and Evaluation (GRADE). GRADE is a systematic approach to grading the strength of the total body of evidence that is available to support recommendations on a specific clinical management issue.
3. Key recommendations for care are defined by GRADE.

Document Overview

Document Title: Adult Strabismus

Authoring Society: American Academy of Ophthalmology

Document Publication Date: Feb 12, 2024

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: www.aaojournal.org/article/S0161-6420(24)00013-7/fulltext

Source Citation: Dagi LR, Velez FG, Holmes JM, Archer SM, Strominger MB, Pineles SL, Paysse EA, Pihlblad MS, Atalay HT, Campolattaro BN, Chang YH; American Academy of Ophthalmology Preferred Practice Pattern Adult Strabismus Panel. Adult Strabismus Preferred Practice Pattern®. Ophthalmology. 2024 Feb 12:S0161-6420(24)00013-7. doi: 10.1016/j.ophtha.2023.12.040. Epub ahead of print. PMID: 38349303.

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Document Objectives: Perform a clinical examination and ancillary testing as indicated to diagnose the cause of strabismus. Counsel the patient on the diagnosis and treatment options. Consult other medical providers if the diagnosis indicates the need for multidisciplinary management. Establish priorities in the goal-directed management of strabismus (improved eye contact and appearance of alignment, enhancing binocular potential, or reduction or resolution of diplopia and/or compensatory head posture. Inform the patient's primary care and other health care providers of the diagnosis and treatment plan.

Scope: Assessment and Screening, Diagnosis, Management

Diseases/Conditions (MeSH)

D005128 - Eye Diseases

D013285 - Strabismus

D005128 - Eye Diseases

D013285 - Strabismus

Keywords: Strabismus, cross-eyed, eye misalignment

Inclusion Criteria: Male, Female, Adult

Health Care Settings: Ambulatory, Outpatient

Intended Users: Nurse, Nurse Practitioner, Optometrist, Physician, Physician Assistant

Recommendation Development Processes & Methodology

Supplemental Methodology Resource: Methodology Supplement

Number of Source Documents: 437

Literature Search Start Date: Sunday, January 1, 2023

Literature Search End Date: Friday, April 1, 2022

Includes peer/external review process?: Yes

Includes public comment process?: No

Methodologist involvement?: Yes

Patient involvement?: Yes

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: No