Strabismus Surgery

Strabismus surgery is one way to straighten the eyes. This is done by operating on one or more of the muscles connected to your eyeball, and does not involve cutting into the eyes themselves or popping the eyeball out of its socket. The doctor may decide to shorten the muscle, or move the muscle in order to even out the imbalance of the pull of the other muscles on your eyeball. The amount by which the muscle will be shortened or moved will depend on the measurements obtained prior to your surgery. The end goal is for the muscles to have balanced pull on your eye in order to keep it straight. This surgery usually takes 30-45 minutes per eye. Usually, only one operation is needed, however in some cases, subsequent surgery/surgeries may be required in order to improve results.

The aim of the surgery will change depending your specific circumstances. These aims can include:

Improvement of double vision, if double vision is present
Improve depth perception
Improve appearance of misaligned eyes, being an incredibly important aspect for a person’s normal psychological development

It is important to note that not all cases of strabismus will benefit from surgery. Your doctor will suggest strabismus surgery to you if they think it will be advantageous to your particular situation.

Before surgery

Prior to your surgery, we will do a series of assessments, such as testing your vision as a baseline for later changes, a measurement of your eye misalignment, and to check that there is no paralysis of the muscles or anything blocking it from moving. We will also ask you about your medical history, including medications, in order to tailor the surgery based on your health, as well as to ensure nothing used before, during, or after surgery will affect your current medications or treatment. For this reason, it is important to disclose your full medical history.

Please let us know if you have:

Any allergies or previous reactions to anaesthetics/medications/dressings/surgical tapes
Any family history of a severe reaction to anaesthesia
Prolonged bleeding or excessive bruising when injured
History of blood clot problems (both being diagnosed with the inability for the blood to clot, or having blood clots in any part of your body)
Recent or long-term health issues
Psychological or psychiatric illness
History of keloid scars, or poor healing of scars

We will also ask for a full list of medications that you are taking, or have recently taken. This includes eye drops, medications prescribed by other doctors outside the practice, over the counter drugs, and any long-term medications. Depending on your situation, some of these medications may need to be stopped prior to your surgery to avoid complications, however it is important that you do not stop these medications on your own without the doctor’s advice. Your doctor will discuss these carefully with you depending on your health needs.

Do not take large amounts of vitamins (especially vitamin E), garlic tablets, or anti-inflammatory medicines for at least 10 days prior to the surgery. If you are a smoker it is best to quit, however at the very least please stop smoking at least 2 weeks before surgery as smoking increases the risks of complications with anaesthesia and the surgery itself. It also impairs your healing.

On the day of the surgery

When you come to the hospital, dress in loose, comfortable clothes with buttons or zips to avoid having to remove the clothing over your head, especially after surgery. This is especially important for children.

Strabismus surgery is usually performed under general anaesthesia, but in some adults, this might be done with local anaesthesia. Arrange for a responsible adult to take you home after surgery, and for someone to take care of you for at least 1 day or more while you’re recovering.

Recovery from surgery

Most patients are able to go home a few hours after surgery, however you may need to stay longer depending on the extent of the surgery performed to correct your eyes, as well as the extent of anaesthetic used. Rarely, some patients may need to stay overnight.

In some cases, your surgeon will use adjustable sutures, which will allow them to adjust the position of your eyes after surgery without the need for another operation. This may require you to wait several hours until the adjustment has been completed.

The sutures that your doctor will use on your eye muscles will dissolve over time and will not need to be removed.

You can expect to experience the following after surgery:

Headache during the first few days after surgery, especially as the brain and body is still trying to get used to the change in your eye muscles.
The eyelids will be swollen and difficult to open, and the whites of your eye will be red or “bloodshot”. This should subside gradually over the next 4-6 weeks.
Watery eyes, and there may sometimes be blood in the tears on the first day after the operation.
Mild “crusting” of the dried tears/fluid on the eyelids.
Some scratchiness, irritation and/or soreness and pain. While this is normal, please let your surgeon or the nursing staff know if you are experiencing severe, unreasonable pain.
Sometimes you may get some nausea or vomiting after surgery, usually due to the anaesthetic, but you may be given medication prior to the operation in order to prevent this.
You may have some double vision or other mild disturbances in vision for a short time after surgery. Ask your surgeon when you can expect to return to normal vision. In some patients, depending on your circumstances and the surgery required, the outcome may not be apparent until after 6 weeks or more.
There will be a noticeable difference in the alignment of the eyes straight after surgery. The eye may vary in alignment – moving in and out – for the first few days following surgery as the brain re-learns to control the realigned eye.

Risks and complications of strabismus surgery

Modern surgery is now safer than ever, however all surgeries have a level of risk. Despite the highest standards of medical practice, complications are still possible.

The following information is designed to inform, not to alarm. It is unlikely for these complications to occur, however it is important that you are aware of the possible risks in order to make an informed decision.

General surgery risks

After any type of surgery, one or more of these things may occur:

Wound infection (may be treated with antibiotics if applicable)
Pain around the area of surgery
Accumulation of blood around the surgical site (a.k.a. haematoma)
Nausea (often a side effect of anaesthesia and usually settles down)
Separation of wound edges
Scarring
Allergic reactions (could be caused by anaesthesia, sutures, dressings, antiseptic solutions, especially when previously unaware of such allergies)
Slow healing (often due to general health e.g. having diabetes or being a smoker)

Specific risks from strabismus surgery

One or more of the following may occur specifically after strabismus surgery:

The operated eye may not end up in its intended position. There may still be some residual eye turn, or it may end up turning in the opposite direction. These may be visible straight after surgery, or may appear some time after. In this case, a second surgery may be required.
Changes in eye alignment may also happen months or years down the track, due to the natural process of ageing, changes in health, or other reasons.
An area of redness in the whites of your eyes around the site of the surgery may persist for months later.
Your glasses prescription may change.
If surgery is performed on three or more muscles, blood supply to the front of your eye may be impaired.
Double vision may still be present after surgery in adults or older children. This usually resolves after 4 weeks. Sometimes, about 2 patients out of 100 may have long term double vision, which may need further surgery, prisms in glasses, or patching to further improve this issue.
If the outer covering of your eye is very thin, it may tear when the muscles are stitched on it. The layer under the sclera (the white, outer layer of your eyes) called the choroid, or the inner lining inside your eye called the retina, can also sometimes be damaged. This can lead to infections or retinal detachment, which can very rarely cause permanent blindness in the affected eye.
Exceptionally rarely, about 1 in every 40 000 patients may end up with partial or complete loss of vision, or loss of eye.