Strabismus surgery

Overview 

Strabismus surgery, also referred to as eye muscle surgery, is a medical procedure aimed at realigning the eyes by adjusting the eye muscles. This is achieved through techniques such as tightening, loosening, cutting, folding, or repositioning the muscles, allowing the eyes to work together effectively. The surgery is typically recommended for correcting misalignment in cases where other treatments have been ineffective and can be performed on one or both eyes.  

Types  

Strabismus surgery can be done in different ways. In some cases, both eyes may require treatment known as bilateral strabismus surgery. 

In certain circumstances, adjustable surgery may also be recommended. This allows a healthcare provider to adjust the muscle sutures to correct any remaining misalignment in the recovery area or clinic shortly after the initial strabismus surgery in the operating room.

The types of eye muscle surgery include:  

• Recession: This involves moving the muscle back to reduce its tightness.  
• Resection: This refers to shortening the muscle by cutting it.  
• Plication:  The muscle is shortened by folding it over.  

Reasons for undergoing the procedure  

Strabismus surgery is typically recommended for children but is also applicable to adults, who had non-surgical interventions but are ineffective.

Conditions that may be treated with strabismus surgery include:  

• Stroke: Following a stroke, vision complications may occur.   
• Nystagmus: This is characterized by an involuntary eye movement.  
• Hypertropia: This occurs when one eye is positioned higher than the other.   
• Hypotropia: This occurs when one eye is positioned lower than the other.  
• Exotropia: This is characterized by one or both eyes turning outward, away from the nose and towards the ears.  
• Esotropia: This is characterized by one or both eyes turning inward, toward the nose.

Approximately 5% of the population is affected by strabismus, a condition characterized by eye misalignment.  

Risk 

Like any surgery, an eye muscle surgery carries some risks. A possible complication is recurrent misalignment, where the eyes may revert to their original misaligned position or over-correct, causing them to misalign in the opposite direction. However, this surgery is considered generally very safe.

Other potential complications include:  

• Puncturing the cornea, or the white part of the eye  
• Ptosis, or drooping eyelids  
• Experiencing diplopia, or double vision  
• Excessive bleeding  
• Having an allergy to drugs or anesthetics  
• Infection  
• Scarring  

Before the procedure  

Before undergoing strabismus surgery, a final eye exam will be conducted to identify which eye muscles need adjustment. The healthcare provider will review the patient’s medical history, including any past or current conditions and previous eye muscle surgeries.

It is also important to inform the healthcare provider of the following:  

• Any allergies  
• Family history of anesthesia issues  
• Medications, such as blood thinners 

The healthcare provider may also provide specific instructions, particularly during a pre-anesthesia visit, such as:  

• Stop taking certain medications  
• Stop eating and drinking, usually after midnight  

During the procedure  

Strabismus surgery typically lasts between 30 minutes and two hours. General anesthesia is administered to all children and most adults, though some adults may only receive eye numbing and light sedation. Vitals signs are also monitored throughout the procedure.

These may be expected during the surgery:  

• Medication is administered intravenously (IV).  
• An eye speculum is used to keep the eye open.  
• An incision is made in the conjunctiva.  
• Muscles are repositioned with a hook and secured with dissolvable stitches.  
• The speculum is removed, and eye drops, or ointment are applied.  

After the procedure  

The healthcare provider will give specific instructions, such as:  

• Rest and avoid strenuous activities for up to a week   
• Use prescribe eye drops or ointment at home  
• Take acetaminophen or ibuprofen as recommended, for pain relief 

After the surgery, one will be moved to a recovery room where their vital signs will be monitored until discharge. They may also need someone to stay with them for 24 hours and drive them home.   

Outcome

After surgery, patients should plan to rest for several days to weeks. During this time, it’s common for the eyes to appear red, sore, or scratchy, with a healing period of three to twelve weeks. It’s crucial to monitor for potential complications, and patients should seek immediate medical attention if they experience:  

• Any concerning symptoms  
• A red lump or noticeable expansion of scar tissue  
• Signs of infection, such as fever, discharge, increased redness in the sclera (the white part of the eye), or swelling and redness on the eyelid  
• Persistent eye pain that does not improve  
• Decreased vision

Patients are advised to refrain from driving until cleared by their healthcare provider and to avoid swimming pools, saunas, and hot tubs for two weeks to reduce the risk of infection.  

Generally, strabismus surgery can improve how well the eyes work together, enhancing 3D vision, especially in children. While the procedure effectively corrects eye alignment, it may not directly improve visual acuity. Many individuals find the surgery beneficial as it can boost self-confidence and enhance their appearance.