Strabismus Surgery

Everything You Should Know About Strabismus Surgery and the Recovery Period.


An Overview

Strabismus surgery: what does it really entail? If you need this surgery, what will it look like for you? If you have questions, you’re in the right place. We can help you better understand your surgery and the recovery process.

What Is Strabismus Surgery?

Strabismus surgery is designed to correct strabismus, a condition in which the eyes don’t align properly. People with strabismus may have one eye that consistently points a different direction– up, down, or to one side. Sometimes, the same eye may point consistently in the same direction; in other cases, strabismus may swap eyes or come and go. Sometimes, it is treated with special glasses, patches, or injections. However, in some cases, these treatments may not be enough. Strabismus surgery, performed on the muscles of the eye, is designed to straighten the eyes and restore normal binocular vision.

Why Is Strabismus Surgery Necessary?

Strabismus surgery may be performed on either adults or children, often based on the severity of the eye’s misalignment. The surgery is designed to restore normal binocular vision and make it possible for the eyes to operate together again. Strabismus may make it difficult to drive, participate in athletic events, or even participate in normal social interactions since so many human interactions rely on eye contact. Strabismus is far from merely cosmetic. It may create double vision or problems with depth perception in sufferers. Surgery is often recommended in children to help with normal visual development while adults may need surgery, rather than patches or blurring of one eye, to correct an ongoing problem.

Before the Surgery

Before strabismus surgery is performed, you’ll undergo a test in your ophthalmologist’s office to determine which muscles contribute to the strabismus. Your doctor wants to see exactly which muscles are causing the problems. In some cases, muscles will need to be weakened during the surgery; in others, they will be strengthened. Your doctor will use a series of prisms to get a better look at your eyes and the muscles that contribute to its movement.

woman during a strabismus test

During the Surgical Procedure

Typically, strabismus surgery is performed as an outpatient procedure. Unless there are unexpected complications, there is no reason for you to need to stay in the hospital overnight. The procedure itself is generally over within an hour or two; however, the patient can expect to remain in the hospital for several hours for preoperative care and postoperative recovery.

If strabismus surgery is performed on a child, the procedure is generally done under general anesthesia. That is, the patient is asleep for the duration of the procedure. This helps alleviate anxiety and may make it easier on the child in the long run. Adults may have the option of general anesthesia or a local anesthetic, depending on the severity of the condition and their anxiety. Your doctor may have a preference for general or local anesthetic and will communicate this to you before your procedure.

During the surgery, the eye is held open with a lid speculum. The doctor will make a small incision in the mucous membrane of the eye to allow them to access the eye muscles. Then, they will strengthen, weaken, or move those muscles, depending on the type of modification needed to straighten the affected eye. In some cases, only one eye will need surgical intervention. Even if only one eye is misaligned, however, both eyes may require surgery in order to achieve better alignment and vision. Your doctor will let you know what is necessary for your procedure ahead of time.

If the Eye Muscle Is Too Strong

If you have an eye muscle that is too strong, causing the eye to pull too far in one direction, your doctor may detach that muscle and move it further back in the eye. This gives the muscle less relative strength since it will need to work harder to move the eye to its former position.

If the Eye Muscle Is Too Weak

If the eye muscle is too weak, your doctor will detach it and reattach it nearer in the eye. This will increase the muscle’s relative strength, causing it to require less effort to move the eye to its desired location.

Adjustable Sutures

Adjustable sutures allow your eye surgeon to move your eye muscles, then carefully adjust their final position after the surgery is over. This often improves the overall outcome of the procedure and allows for better alignment of the eyes overall. Between 4 and 24 hours after your initial procedure, your surgeon will take you into the office and remove the patch over your eye. Then, they will use the sutures to adjust the positioning of the muscle, either tightening or loosening it based on your current eye position. This careful maneuvering can help achieve a more exact position with the first surgical procedure.

Adjustable sutures are not used on children. They may cause some discomfort when the suture is adjusted, especially if the muscle needs to be tightened; however, this discomfort is relatively mild and generally passes quickly.

Your Surgical Procedure

Thanks to testing in the office prior to your surgery, your eye surgeon will be able to give you a good idea of what to expect during your procedure. However, sometimes, the surgeon will discover things during the procedure that need to change the course of the surgery. In this case, there may be alterations to the original surgical plan during the surgery itself. For example, your surgeon may discover that you are not a good candidate for adjustable sutures after all, or that a different muscle needs to be moved in order to achieve alignment.

After Your Surgery

If you need to have strabismus surgery, you may find yourself concerned about the recovery period. What will it look like? When can you expect to get back to normal? There are several things to keep in mind.

Pain Management

Most people who have had strabismus surgery find that they are able to manage pain with over the counter pain medications and cold compresses. In some cases, prescription pain medication can help alleviate that initial discomfort and make it easier to cope with the pain.

Eye Appearance

Following the surgery, there may be small blood spots in the white of your eye. This is perfectly normal and no cause for concern. These red spots will fade within a few days to a few weeks.

Returning to Normal Activities

Adults who have had strabismus surgery should not drive on the day of the procedure. If you have double vision after your surgery–a common side effect that may last up to two weeks–you should not drive until the double vision resolves itself. You may want to stay out of work for up to two days after the procedure, and a child who has the procedure should plan to be out of school for at least two days following the procedure. Generally, people who have had strabismus surgery are able to return to normal activities within two weeks; however, you should always consult with your doctor about returning to normal activities after surgery, especially when it comes to participating in sports or other strenuous activities. You should not swim for two weeks after the procedure.

Side Effects

There are several common side effects after strabismus surgery. Sore eyes are commonly reported, generally with relatively easy pain management. You may suffer from double vision lasting for a few hours, a few days, or up to two weeks after your surgery. Residual misalignment is also common. It’s rare for strabismus surgery to perfectly align the eyes, yet most surgeons can bring about substantial improvement.

When to Call Your Doctor

Your doctor will provide you with a list of what to expect after your procedure, including post-surgical care. If you experience any of the following symptoms, however, you should contact your doctor immediately.

  • You see any signs of infection, including pus or discharge around the eye
  • There are obvious signs of bleeding in the eye. This does not include faintly pink tears or red spots in the eye, which are considered normal after surgery.
  • Vision appears to change significantly after the surgery.
  • Pain becomes more serious suddenly or is not alleviated by pain medication.
  • The eye becomes significantly more light sensitive, including being unable to open the eye in the light.

Other Things to Know About Strabismus Surgery

If you’re planning strabismus surgery, there are several important things to keep in mind ahead of time.

Strabismus may not correct vision. In many cases, surgical success is defined as an improvement in appearance, not in your ability to see. While it may correct problems like double vision, you may need additional treatment, including glasses or contacts, to achieve clear vision.

You may need more than one surgery. In some cases, the eye may return to its former position. Children, in particular, often need more than one surgery to help correct strabismus.

Your insurance company will often cover strabismus surgery. Since strabismus is not purely cosmetic, many insurance companies do cover the procedure.

Are you considering a strabismus procedure? Do you need further evaluation? Contact us today to learn more about how we can help.