Surgical Treatment for Strabismus

When the muscles of the eye do not all function in the same way, one or both eyes may wander in different directions without being able to focus completely on one subject. This misalignment of the eyes is called strabismus, and it is generally discovered during childhood..

Strabismus can be caused by one of the six muscles of the eyes being stronger or weaker than the rest. The condition can often be corrected with the use of eye patches, glasses, or eye drops, but surgery is sometimes necessary. The minimally-invasive surgery will allow the muscle to become weaker or stronger based on the patient’s situation.

One of the most common surgical procedures for correcting strabismus is recessive and re-sectioning surgery. During this surgery, your child’s eye surgeon will access the muscles of the eye through the back of the eye. The surgeon will remove the muscle that is causing the misalignment and will reattach it in a way that will allow it to function properly. This is generally done on muscles that are too strong and can help the muscles to move in a more uniform pattern, while preventing the eye from wandering.

Muscles that are too weak are difficult to strengthen, so the opposing muscles of the affected one will be recessed and reattached in a way that allows all of the muscles to function in unison. Depending on the specific case, all of the eye muscles may be restructured to ensure that the eye is able to remain focused.

While re-sectioning surgery is more common, adjustable suture procedures can also be performed on children who develop strabismus. This procedure involves sutures being added to the muscles of the eyes and being tightened as needed to help increase the strength of the muscles.

Before recommending surgery Dr. Fazilat will have carefully considered correction through eyeglasses, patching, eye drops, or prisms.

Strabismus surgery can be performed in children as young as four months of age. When surgery is performed at an earlier age better results are obtained. At an earlier age the brain is more adaptable for developing binocular vision and depth perception. However, strabismus surgery can still be done in older children and adults, as these brain developments continue to have some adaptability. Strabismus surgery can also be performed for social and developmental reasons.

Under corrections and over corrections may occur, because not everyone’s eye muscles and brain respond in the same way to the same amount of surgery. Approximately 80% of patients do not need a second surgery but 20% need a re-operation a few months to a few years after the first surgery to ensure proper ocular alignment.

Strabismus surgery is performed as an outpatient procedure. Patients arrive one hour before the scheduled procedure and return home a few hours after its completion. Serious complications are rare and strabismus surgery is considered one of the safest ocular surgeries. However, there is potential risk of retinal detachment, blinding ocular infection, or severe anesthetic reaction in one in 2,500 cases or less.

What to Expect:

Before Surgery

The night before surgery, no food or milk after midnight should be eaten. Medicines may be taken with sips of water. Please refer to the surgical center’s Pre-Op regulations.

If you or your child has a fever, deep cough or vomiting in the days before surgery, please call us.

The time of day you’ve been given for the operation may change the day of surgery. Usually children are taken by age, with the youngest going first. This is not applicable for adults.

You will be seen by the anesthesiologist and Dr. Fazilat prior to the operation. This will allow you to ask your last minute questions.

During Surgery

Strabismus surgery in children and adults are done under general anesthesia. Before surgery, a medication is often given to children to alleviate their anxiety of being separated from their parent. A young child will be put to sleep within seconds by breathing gas from a mask held near his or her face. After the patient is sleep an intravenous (IV) line and a breathing tube (endotracheal tube) are placed and the breathing tube is removed before he or she is fully awake. Older children and adults may be given an IV line of sedatives beforehand. The anesthesiologist may alter the routine depending on the patient’s needs.

After the patient is fully asleep, Dr. Fazilat will make an incision on the thin covering over the white part of the eye, without taking the eye out, in order to isolate the muscles. Typically several eye muscles (usually in both eyes) will be repositioned using microsurgery. The muscles will be stitched at the new position based on the measurements obtained during the office visits. We can’t use lasers on the eye muscles because they would destroy the eye muscles. No stitches have to be removed. The stitches will be absorbed by themselves as the muscle heals.

Strabismus surgery is usually completed within an hour, although this may vary slightly depending on the complexity of the case. Immediately after the surgery, Dr. Fazilat will find you or your family to discuss the results.

During Recovery

The patient will be taken from the Operating Room to the Post-Anesthesia Recovery room. Patients will be monitored by the nurses until the patient is fully awake. After 15-30 minutes, the family can join you or your child. During this time you or your child will be encouraged to drink juice. The intravenous line will be removed.

The eye will not be patched. There may be mild light sensitivity, eye soreness or a scratchy sensation. You may see a few drops of blood stained tears draining from the eyes. You can remove the tear lightly with a washcloth or tissue. Do not rub the eyes. If you wear glasses you may put them on at this time.

There may be mild discomfort from the surgery, and mild nausea. Appropriate medication will be given by the nurses.

You will be discharged most likely within two to three hours after surgery.

At Home

You will be given antibiotic drops and ointment to help with the healing and to prevent infection in the first week after surgery. You should start using the eye drop the day of surgery and at night apply about ¼ inch of ointment just inside the lower eye lids or on the lower lashes of the operated eye, for seven days. You can give your child Tylenol for any mild pain.

Once home, you or your child can resume all normal activities. Younger children often play within hours after surgery, although some children may be tired and need to recover from anesthesia for an extra day or two. You may take a bath; however, place a wash cloth over the eye to prevent any water from getting into the eyes for the first week. Avoid submerging the eyes in a bath or swimming pool for two weeks. You or your child can return to day care, school or work one or two days after surgery. However, for a more active young child he or she can stay home for one week. Redness of the eyes usually disappears within a few weeks.

We usually can’t tell if the surgery “worked” until weeks or months afterwards, as the brain circuits adapt to the new position of the muscles to get the eyes to track together. We can estimate the success of the surgery in the first post op visit. But the final precise judgment will be done in three to four months after surgery.

Temporary double vision is common for several weeks after surgery, because the brain is not accustomed to the new position of the eye. If the double vision persists then Dr. Fazilat may prescribe prisms or recommend surgical correction.

On Follow-Up Exams

You will be seen usually one week after the surgery and one month following the surgical date. Further evaluation will be determined at that time.