Strabismus is misalignment of the eyes, and occurs with children and adults. If the eyes are out of alignment, one eye or the other is not used at any given moment, which impairs visual attention, depth perception and motor skills. Misalignment of the eyes also can cause bothersome double vision.
Before recommending surgery, your ophthalmologist, Dr. Packwood, Norman or Hunt, will have carefully considered correction through patching therapy, eyeglasses or prisms. Eye drops are occasionally used before or after surgery, but can never correct eye alignment on a long-term basis.
Strabismus surgery can be performed in children as young as four months of age and is an important option for older children and adults as well. It’s better to perform surgery as early as possible, because the brain circuits for binocular vision (using the two eyes together) are most adaptable at a young age. Strabismus surgery can still be performed in older children and adults, as these brain circuits continue to have some adaptability.
Undercorrections and overcorrections may occur, because not everyone’s eye muscles and brain circuits respond in the same way to the same amount of surgery. Approximately 70 to 85% of patients (depending upon the type of strabismus) have long-term stable eye alignment after one surgery. Twenty to 40% of patients who do not have proper alignment after the first surgery may need re-operation a few months to a few years after the first surgery to ensure the results from the first surgery have stabilized. It’s almost always possible to perform a re-operation if necessary.
Strabismus surgery is performed as an outpatient procedure, allowing patients to arrive as little as one hour before the scheduled procedure and return home a few hours after its completion. Serious complications are rare; the risk of retinal detachment, blinding infection in the eye, or severe anesthetic reaction is one in 2,500 or less. Strabismus surgery is considered one of the safest of all eye procedures.
What to Expect
On the night before surgery, don’t have food or milk after midnight. Medicines may be taken with sips of water. Only apple juice and water may be taken up to three hours before the admission time. See the Hospital Pre-Op page.
If you or your child is acutely ill (has a fever, deep cough or vomiting) in the days before surgery, please call us at (817) 529-9949.
The time of day you’ve been given for the operation is tentative and may need to be changed on the day of surgery. In general, patients are taken by age, with the youngest going first. This is not applicable for adults.
The anesthesia doctor may order a preoperative oral sedative. A young child will be put to sleep within seconds by breathing gas from a mask held near his or her face. An intravenous (IV) line and a breathing tube (endotracheal tube) are placed only after the patient is asleep, and the breathing tube is removed before he or she is fully awake. Children age 13 or older who are not unduly frightened may be given an IV line of sedatives beforehand. Depending on the special needs or medical condition of a patient, the anesthesiologist may slightly alter the routine.
After the patient is fully asleep, several eye muscles (usually on both eyes) are repositioned using microsurgery. Using special instruments, we rotate the eye so we can make the incision in the thin covering over the white of the eye, without taking the eye out of the head. We can’t use lasers on the eye muscles because they would destroy the muscle tissue. Instead, we’ll use tiny stitches to reposition the muscles based on measurements obtained during office visits and with your child asleep. No stitches have to be removed; when the muscle is healed, the synthetic stitches will absorb by themselves.
Strabismus surgery is usually completed within an hour, although this may vary from 30 minutes to 90 minutes depending on the complexity of the case. Immediately after the surgery, Dr. Packwood, Norman or Hunt will find you or your family to discuss the results.
The patient will be taken from the Operating Room to the Post-Anesthesia Recovery Unit, to awaken more fully while being monitored by the nursing staff. After 15-30 minutes, your or your child will be encouraged to drink juice or eat a Popsicle while we remove the intravenous line, and family can join you from the waiting room.
Eye bandages are not usually applied. There may be mild light sensitivity, eye soreness or a scratchy sensation. You may see a few drops of blood stained tears draining from the eyes. These can be wiped away with a washcloth or tissue. We discourage any rubbing of the eyes.
There may be mild discomfort from the surgery, and mild nausea is common. The nurses will treat any discomfort with appropriate medication. We discharge most patients within two to three hours after surgery.
As you are discharged, the nurse will provide you with antibiotic drops or ointment to help healing and prevent infection in the first week after surgery. Beginning that night, squeeze about ¼ inch of ointment or one drop just inside the lower lids or on the lower lashes, for seven days. You can give your child Tylenol for any mild pain.
Once home, your or your child can resume all normal activities. Younger children often play within hours after surgery, though some children may be tired, grouchy or nauseated for a day or two. Bathing, showering and washing of the hair won’t interfere with healing, but avoid submerging the eyes in a bath or swimming pool for seven to 10 days after surgery. You or your child can return to day care, school or work one or two days after surgery. Redness of the eyes usually disappears in a few weeks.
We usually can’t tell if the surgery “worked” until weeks or months later, as the brain circuits adapt to the new position of the muscles to get the eyes to track together. We’ll estimate the success at your visit one week after the surgery, and provide a more precise judgment three to four months after that.
Temporary double vision is common for several weeks after surgery, because the brain is not accustomed to the new position of the eye. Very few patients experience double vision for months or longer; in those cases, Dr. Packwood, Norman, or Hunt may prescribe prisms to alleviate the problem.
On Follow-Up Exams
The Surgery Scheduler will set up a time for the first brief post-operative check, 5-10 days after the surgery. If you wish to arrange the appointment yourself, call (817) 529-9949 and tell the receptionist you need to schedule a post-operative check-up. We’ll usually perform a second post-op check six weeks after the surgery.