Strabismus Surgery

What is Strabismus?

Strabismus, more commonly known as cross-eyed or wall-eyed, is a condition in which both eyes cannot be simultaneously aligned. One or both of the eyes may turn out, in, down or up. An eye turn may be constant or intermittent. Whether in adults or children, Strabismus does not go away on its own but is treatable. Treatment is necessary to correct Strabismus.

What are non-surgical Strabismus treatments?

The medical term for eye muscle training is Orthoptics, which is provided by orthoptists and/or optometrists, which address the teaming of the eyes together (synchronous movement and alignment) and visual clarity. There are several differences between Orthoptics and Vision Therapy. Orthoptics considers Strabismus an eye muscle problem, and treatment is guided toward strengthening the muscle. Optometrists who administer Vision Therapy look at the neurological aspect of eye function and control and thus treat the whole visual system.

Vision Therapy can help change the nervous system as a whole, thus resulting in an enduring cure. In general, orthoptics is home-based treatment, while Vision Therapy is performed with the supervision of a doctor in an optometrist's office, with home therapy as a supplement. Office-based Vision Therapy supplemented by home therapy is often more successful than home-based treatment alone. 

What is Optometric Vision Therapy?

Optometric Vision Therapy is an individualized, managed, non-surgical treatment program devised to correct eye movements and visual-motor insufficiencies. Vision Therapy sessions include methods designed to improve the brain's capacity to control:

eye alignment
eye teaming
eye focusing abilities
eye movements
visual processing

Visual-motor skills and endurance are developed through the use of specialized computer and optical devices, including therapeutic lenses, prisms, and filters. During the concluding stages of therapy, the patient's newly gained visual skills are strengthened and made permanent through repetition and by combination with motor and cognitive skills. 

In Vision Therapy programs, developmental optometrists look at the eye-brain interface and thus are treating the whole visual-motor system and altering automatic behavior. Most optometrists rely on office-based therapy, which they believe results in better outcomes compliance.

What is Strabismus surgery?

In children with some types of persistent Strabismus, early surgery may be prescribed to increase the chance of returning or developing normal binocular vision. In adults, eye alignment surgery is more than strictly cosmetic. Eye alignment surgery can restore normal appearance and is recognized as reconstructive surgery. There are many other benefits beyond restoring a normal appearance. Improved depth perception or complete reattainment of binocular vision, improved visual fields, eliminating or reducing double vision and improved social experiences since eye contact is hugely important in human communication and emotional responses.

It is essential to discuss the goals and expectations of the surgery with an ophthalmologist. During strabismus surgery, one or more of the eye muscles are strengthened, weakened, or moved to improve alignment. Strabismus surgery is usually performed as an outpatient procedure and does not require an overnight hospital stay.

How will I know if I need Strabismus surgery?

Before surgery, an examination called a sensorimotor test would be performed in the ophthalmologist's office to determine the alignment of the eyes in order to find out which muscles are contributing to Strabismus and which muscles need to be altered to improve the alignment of the eyes. When an eye muscle is altered, that means it is weakened, strengthened, or moved. Prisms are used to measure the degree of Strabismus. These preoperative tests help guide the surgical plan. Often both eyes require surgery, even if only one is misaligned. Sometimes the exact surgical method is determined based on findings at the time of the operation, especially in reoperations.

What is the procedure of Strabismus surgery?

Strabismus surgery in children requires general anesthesia. Prior to surgery, medication is often given to children to alleviate their anxiety about being separated from their parents. In adults, the procedure can be done with general or local anesthesia. Either way, the patient must fast for about eight hours before the procedure. For that reason, surgeries are scheduled in the early morning.

Strabismus surgery never requires the eye to be removed from the socket. The eyelids are gently held open with a medical tool called a speculum. A small opening is made through the conjunctiva (the mucous membrane surface of the eye) to access the muscle. In regular strabismus surgery, the tissue is weakened, strengthened, or moved, and a permanent knot is placed by the surgeon. In adults, there is the added advantage of using an adjustable suture. Instead of a permanent knot, a temporary knot can be used.

After the surgery, with the patient awake, alignment can be reassessed, and if necessary, adjustments can be made before a permanent knot is placed to minimize the chance of an over-correction or under-correction. This is typically done on the day of or the day after the surgery. Most strabismus surgeries take less than one to two hours; however, the patient will be at the surgery center for several hours for preoperative and post-operative care.  

How long is the recovery from Strabismus surgery?

Any patient that has surgery, whether under general anesthesia or local anesthesia with sedation, needs to be monitored after surgery. In general, children can return to school after two days. Adults should not drive the day of surgery or the day after and may need up to a week of recovery before returning to work. Many people report double vision that can last hours to days or a week or more, but rarely longer.

Pain is minimal and usually over-the-counter medicines, such as ibuprofen or acetaminophen (Tylenol), and cold compresses are sufficient to deal with pain. Adults and older children may need prescription pain medicine. The main restriction after strabismus surgery is not swimming for two weeks. The eye(s) will be red for one to two weeks, rarely longer, especially if it is a reoperation.

What are the potential risks of Strabismus surgery?

The chance of any serious complication from strabismus surgery that could affect the sight or well-being of the eye is exceedingly rare. However, there are risks with any surgery, including:

Sore eyes
Residual misalignment
Double vision
Corneal abrasion
Decreased vision
Retinal detachment
Anesthesia-related complications

Strabismus surgery is a standard procedure, and most patients will see a significant improvement in the alignment of their eyes after surgery. In some cases, a patient may need additional surgery or prism glasses to align the eyes optimally. Each instance of Strabismus is unique and should be discussed with an ophthalmologist to understand the goals and expectations of surgery.  

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