Strabismus surgery

Strabismus surgery is done to correct an eye condition called strabismus. In this condition, a person's eyes are not aligned properly, as a result, their eyes focus on different objects at the same time. This condition is also called crossed eyes.

Typically, human eyes have six muscles to regulate eye movements. Brain sends signals to these muscles that help both the eyes to point/focus in the same direction. This alignment is needed for better depth perception and to prevent double vision. However, individuals with strabismus either have a faulty transmission of signals between the nerves and eye muscles, damage to the part of the brain that controls eye movements or damage to their eyes or eye muscles. Such conditions may result in the misalignment of eyes; that is, their eyes may turn in, out, up or down. Misaligned eyes send two images to the brain, resulting in confusion and double vision. Strabismus can develop in children or adults. The condition may worsen if left untreated. 

There are various treatments available for correcting strabismus, such as vision therapy, prisms, eyeglasses as well as eye muscle surgery. Strabismus surgery is a safe and common procedure that involves tightening or loosening the eye muscles to reposition them so that both eyes focus in the same direction when the individual wants them to. Some individuals require more than one surgery to correct misalignment of eyes.

An eye surgeon will recommend this surgery in children or adults with strabismus if other treatment methods do not help with the condition. People with strabismus may have one or more of the following symptoms:

• Misaligned eyes
• Double vision
• Trouble while reading
• Squinting a lot or tilting of the head to try and see things more clearly

The surgery is usually recommended early on when strabismus is diagnosed, especially in infants and children as the chances of achieving a normal or binocular vision after surgery reduces with increase in age.

There are no specific contraindications for a strabismus surgery. However, individuals with disorders of the blood vessels (such as an aneurysm) are at an increased risk of complications from strabismus surgery. An eye surgeon may perform this surgery carefully in such individuals.

The eye surgeon will need you to visit the hospital for a preoperative assessment, wherein he/she will conduct several tests to ensure your eligibility for the surgery. They will conduct some eye tests to obtain your eye measurements. In addition, the eye surgeon will ask you certain details about yourself and provide specific instructions to prepare for the surgery. Some of the discussions you may have with the eye surgeon include:

• You will be asked to share your medical history.
• The surgeon will ask you whether you are pregnant, or whether you have any allergies or any coexisting health conditions.
• If you are smoker, you would be advised to discontinue smoking as it would otherwise put you risk of complications.
• Your doctor will ask you to share a list of all the medicines you are taking, including over-the-counter drugs and herbs.
• If you are taking medicines that are used for thinning blood such as aspirin, ibuprofen, etc., the surgeon will ask you to stop using them one week before the scheduled day of the surgery.
• The surgeon may ask you to fast from midnight before the surgery to reduce the risk of vomiting, which is one of the side effects of anaesthesia
• You will be suggested to bring a family member, friend or a responsible acquaintance to drive you home after discharge from the hospital and accompany you for the next 24 hours.
• Additionally, you will be asked to remove all your jewellery, make-up and nail polish before arriving at the hospital on the day of surgery.
• Make sure to wear loose and comfortable clothes when going to the hospital

After arriving at the hospital on the scheduled day of the surgery, the hospital staff will provide you with a hospital gown. An anesthesiologist and a surgeon will visit you to discuss the type of anaesthesia required and the details of the surgery. They will also ask you to sign a consent form granting formal approval for the surgery. The hospital staff will measure your weight and vital signs. Then, they will take you to the operation theatre. Some hospitals allow parents to accompany their children in the operation theatre during the surgery. The procedure usually involves the following steps:

• The anesthesiologist will administer general anaesthesia to put you into a deep sleep. It will be administered either through a vein (intravenously) or through a gas mask.
• Once you are asleep, the surgeon will use a device called lid speculum to keep your eye open. The surgery might be performed in one eye or both the eyes.
• The eye surgeon will introduce a small incision on the transparent covering around the white portion of your eye to access your eye muscles.
• He/she will reposition your eye muscles with dissolvable stitches for the proper alignment of your eyes. These stitches are usually placed behind the eyes; hence, they are not visible.
• Next, the surgeon will close the incision on the outer part of your eye with dissolvable stitches and may place a patch on the operated eye.

The surgery usually lasts for about half an hour or a complete hour. In some adolescents and adults, the surgeon might need to readjust the eye muscles after they have woken up from anaesthesia. This procedure is performed by using a numbing medicine called local anaesthesia. Most of the individuals undergoing this surgery are discharged on the same day. However, you will be kept under observation in the recovery room until your vital signs are stable. You will need to stay at the hospital for a few hours until you are fully awake and are able to consume liquid food. The eye pad will be removed either before discharge or on the next day after the surgery.

You may experience some temporary side effects after the surgery, which will subside within a few days to months. Some of these include:

• Red eyes (persists for two months)
• Blood in tears (lasts for one to two days)
• Pain in the eye (continues for a few days)
• Double vision (persists for one week or longer)
• Itchy eyes (lasts for a few weeks)

Prior to your discharge from the hospital, the eye surgeon will provide you with specific instructions for care after the surgery. Some of these instructions are as follows:

• You may be prescribed some eye drops or ointment for applying in the eyes. Use them as directed.
• Avoid contact sports such as kabaddi and swimming for two to four weeks. You (or the child) may be able to return to other physical activities in a week following surgery.
• Do not use soap or shampoo near the operated eye while washing or taking a shower.
• You (or the child) would be able to resume reading and watching television within a few days once you (or the child) start feeling well enough.
• You will be able to resume work or your child will be able to go to school after resting at home for a week.
• Avoid the use of make-up near the operated eye for at least four weeks after the surgery.
• Do not let your child use face paint or play in the sand for at least two weeks.
• You should not drive at least for the first two days following surgery or if you experience double vision.

Strabismus surgery helps in correcting the misalignment of the eyes. It allows both of your eyes to focus in the same direction. Additionally, the surgery helps in improving appearance, as well as depth perception and peripheral vision.

When to see the doctor?

You should contact the eye surgeon if you observe any of the following after the surgery:

• Swollen eyes
• Persistent vomiting
• Discharge from the eyes
• Fever with a high body temperature
• Seizures
• Loss of vision
• Pain in the operated eye that worsens with time

The potential risks associated with this surgery are as follows:

• The requirement of additional surgeries to rectify strabismus
• Infection
• Permanent double vision
• Loss of vision
• Risks of anaesthesia such as lung infection, confusion and heart attack

A follow-up appointment will be scheduled within four to six week after the surgery to assess the progress of recovery of the operated eye and to see whether you (or the child) needs further treatment.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.