What is Strabismus Surgery?
Strabismus surgery or eye muscle surgery is a corrective treatment for eye misalignment (strabismus).
Eyes that aren’t straight (strabismus) can be realigned with surgery. This outpatient procedure usually takes about 45 minutes, is well-covered by insurance, and has a high long-term success rate. It can be done for any type of eye misalignment, and, by realigning your eyes, can allow the eyes to work together, reduce or eliminate double vision, and help you avoid those awkward conversations when people ask “are you looking at me?”
Strabismus in children
Strabismus is a misalignment of the eyes. Most of us are fortunate because our eyes started to work as a team very early in infancy and have continued to work together ever since. We are able to focus each eye on whatever we look at, regardless of the direction, and our brain combines the picture or image from each eye into the mental picture that allows us to see in three dimensions. However, for about two percent of every 100 children, both eyes are not directed or focused at the same object, and the eyes do not work as a team.
The child with strabismus rarely complains. In most cases, it is the appearance of the eye that first catches the parent’s attention. A child should be examined by an optometrist whenever the eyes appear misaligned.
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Causes of Adult Strabismus
Adults can have strabismus (eye misalignment) for a variety of reasons. Many of them have had eye muscle issues since early childhood and may have even had prior eye muscle surgeries. Some may also have had a pre-existing tendency for strabismus (called a phoria) which their brains had always been able to control in the past. In either case, sometimes the brain can lose control of the eye alignment at some point later in life.
Trauma is another potential cause of strabismus. Injuries to either the eye muscles themselves or the nerves that go to them can result in eye misalignment. One example of this would be an orbital fracture where one of the walls of the eye socket is broken and can trap or damage one of the muscles or nerves. Traumatic brain injuries can also result in nerve palsies that limit eye muscle movement and cooperation.
There is also a range of medical causes for adult strabismus. Systemic diseases like diabetes mellitus, thyroid disease (like Grave’s disease), or myasthenia gravis can all affect eye muscles in their own ways. Neurologic problems like brain tumors, multiple sclerosis, and aneurisms are also important causes that your eye doctor will consider.
Why is surgery needed for Strabismus?
People with strabismus find it difficult to control their eyes. One eye may look directly at an object, while the other may look in a different direction. When misaligned eyes haven’t responded to other treatments, strabismus surgery is recommended.
Different types of strabismus that necessitates surgery?
- Exotropia: One or both of the eyes turn outward toward the ears.
- Esotropia: One or both of the eyes turn inward toward the nose.
- Hypertropia: One eye turns upward as compared to the other eye.
- Hypotropia: One eye turns downward as compared to the other eye.
Who needs Strabismus surgery ?
If strabismus is latent the condition is called a “-phoria” and if it is present all the time it is a “-tropia”.
Condition of Phorias does not need a surgery.
Esotropias measuring more than 15 prism diopters (PD) and exotropias more than 20 PD that have not responded to refractive correction can be considered candidates for surgery.
Can you have strabismus eye surgery in both eyes at same time?
Yes, you can have strabismus surgery on one or both eyes. Bilateral strabismus surgery is the term for when you have the surgery on both eyes.
How effective is strabismus surgery
Strabismus surgery is effective 80-90 percent of the time. Some patients, depending on their age and type of strabismus, will require multiple procedures for optimal results.
What is the Success Rate for Strabismus Surgery?
There are dozens of factors and every single case is unique and the way the brain handles the surgery will depend on the person
Will strabismus surgery give me clear vision?
If you or your child has been diagnosed with strabismus, surgery is an effective way to improve eye alignment.
However, Strabismus surgery doesn’t typically change your glasses prescription and won’t change the clarity of your vision.
Many people who’ve had the surgery appreciate increased self-confidence.
Procedure of strabismus surgery
The goal of strabismus surgery is to correct misalignment of the eyes. This is achieved by loosening or tightening the extraocular muscles in order to weaken or strengthen them, respectively.
There are two main types of extraocular muscles – rectus muscles and oblique muscles – which have specific procedures to achieve the desired results.The amount of weakening or strengthening required is determined through in-office measurements of the eye misalignment.
Rectus muscle procedures
The main procedure used to weaken a rectus muscle is called a recession.This involves detaching the muscle from its original insertion on the eye and moving it towards the back of the eye a specific amount. If after a recession the muscle requires more weakening a marginal myotomy can be performed, where a cut is made part way across the muscle.
rectus muscles strengthening procedure is of 2 type
a)resections and
b)plications.
A resection is when a portion of the muscle is cut away and the new shortened muscle is reattached to the same insertion point.
A plication on the other hand is when the muscle is folded and secured to the outer white portion of the eye, known as the sclera.Plication has the advantages of being a quicker procedure that involves less trauma
Oblique muscle procedures
There are two oblique muscles attached to the eye – the superior oblique and the inferior oblique – which each have their respective procedures
a) The inferior oblique is weakened through a recession and anteriorization where the muscle is detached from the eye and reinserted at a spot anterior to the original insertion.The inferior oblique muscle is rarely tightened due to the technical difficulty of the procedure and the possibility of damage to the macula, which is responsible for central vision
b) The superior oblique is weakened through either a tenotomy or tenectomy, where part of the muscle tendon is either cut across or removed, respectively. The superior oblique is strengthened by folding and securing the tendon to reduce its length, which is called a tuck.
An adjustable suture procedure
This procedure is performed following a recession or resection procedure in which adjustable sutures were used. During this procedure, the surgeon adjusts the sutures that hold the extraocular muscles in place, and either tightens or loosens them to improve the surgical results and achieve optimal alignment.
This surgery is generally only performed in adults, as the patient remains awake during the procedure with only a local anesthetic. For children with strabismus, a regular suture is typically used.
All sutures dissolve on their own within about six weeks.
Is strabismus surgery safe?
Yes.
Complications that occur rarely or very rarely following surgery include: eye infection, hemorrhage in case of scleral perforation, muscle slip or detachment, or even loss of vision. Eye infection occurs at a rate between 1 in 1100 and 1 in 1900 and can lead to permanent loss of vision if not properly treated
Strabismus Surgery Recovery
With strabismus or eye muscle surgery, recovery time depends on how extensive the procedure was. However, most patients are able to return to their normal activities within a day or two of treatment. You can expect a certain range of side effects during your strabismus surgery recovery, from redness to discomfort. Generally, these postoperative symptoms take a few weeks to a few months to disappear completely. In general, patients see their final results within a month or two of surgery.
Immediately after Surgery
Eye muscle surgery is an outpatient procedure which typically lasts between 30 minutes and two hours. Once the surgeon finishes, patients need an hour or so to wake up from the anesthesia. During this time, your doctor will monitor you to make sure there are no unintended aftereffects. Some patients require suture adjustment a few hours after surgery, which is typically involves little to no discomfort.
What to expect after strabismus surgery
After strabismus surgery, your eyes will look red and feel sore. Some people experience a foreign body sensation in which they feel like something is stuck in their eye. This is due to the sutures and will disappear as the sutures dissolve in the next six weeks.
You may notice blood in the inside or outside corner of your eye, in the surgical area— this is normal and will subside within two to three weeks.
Other symptoms you may experience in the first few days after surgery include:
- Swollen eyelids
- Light sensitivity
- Mild blurry vision
- Double vision
Care after Strabismus surgery
- Keep irritants, such as shampoo, out of eyes for two to three days
- Avoid swimming for at least a week
- Take all medications, including eye drops, as directed
- Apply ice packs as needed to help with pain and swelling
- Avoid wearing contact lenses for one to two weeks
- Attend all follow-up appointments
- Following all of your doctor’s post-operative instructions can prevent infection and minimize scarring or other complications from the procedure.
Strabismus surgery complications?
Watch for signs of an infection or slipped muscle within the first week after surgery:
- Vision loss
- Increasing redness
- Green discharge
- Severe pain during eye movement
- Inability to move your eye
If you see these signs, go visit your doctor.
How long does double vision last after strabismus surgery?
You may have double vision for a few days after strabismus surgery. It can take longer than that for some people. Contact your eye care provider if you have concerns about double vision after surgery.
Can strabismus come back after strabismus surgery?
You may need more than one surgery to correct strabismus. This is more often true with children who have the surgery.
Will I still need to wear my glasses after surgery?
Yes, you’ll still need to wear your glasses after surgery. Strabismus surgery doesn’t typically change your glasses prescription and won’t change the clarity of your vision.
