Strabismus (squint) surgical intervention is not a cosmetic procedure

  • 09 Sep 2016
  • RCOphth

RCOphth Statement

The recently published GMC Guidance for doctors who offer cosmetic surgery [1] is an important document aiming to promote high standards and improve patient safety. This guidance is for cosmetic procedures and refractive surgery.

The College recognises that botulinum toxin and surgical treatment for strabismus* are important procedures that are performed in children and adults to

  • promote, improve or re-establish binocular function
  • manage diplopia
  • restore ocular alignment and balance.

Restoration of ocular alignment is a reconstructive procedure which has been shown to significantly enhance quality of life and social function in both children and adults2-7.

Surgical intervention (including botulinum toxin injections) performed to achieve these aims is thus not a cosmetic procedure and does not fall under the GMC guidance for cosmetic surgery. Commissioning pathways for the management of squints reflect this.

Any cosmetic procedure or procedure not routinely funded by the NHS would need exceptions panel applications to be made on behalf of patients requesting them.

Professional Standards Committee

*A squint (strabismus) is a condition where the eyes point in different directions. Squints are common and affect around one in 20 children. They usually develop before five years of age, but can appear later. For more information visit NHS Choices


  2. Hatt SR, Leske DA, Bradley EA, Cole SR, Holmes JM. Comparison of quality-of-life instruments in adults with strabismus. Am J Ophthalmol. 2009;148:558–62
  3. Hancox J, Sharma S, MacKenzie K, Adams G. The effect on quality of life of long-term botulinum toxin A injections to maintain ocular alignment in adult patients with strabismus. Br J Ophthalmol. 2012;96:838–40
  4. Hatt SR, Leske DA, Liebermann L, Holmes JM. Changes in health-related quality of life 1 year following strabismus surgery.  Am J Ophthalmol. 2012;153:614–9
  5. Durnian JM, Owen ME, Baddon AC, Noonan CP, Marsh IB. The psychosocial effects of strabismus: Effect of patient demographics on the AS-20 score. J AAPOS. 2010;14:469–71
  6. Archer SM, Musch DC, Wren PA, Guire KE, Del Monte MA. Social and emotional impact of strabismus surgery on quality of life in children.  J AAPOS. 2005;9:148–51
  7. Jackson S, Morris M, Gleeson K. The long-term psychosocial impact of corrective surgery for adults with strabismus. Br J Ophthalmol. 2013;97:419–22