Eye muscle surgery involves making an incision in the conjunctiva, the outer cellophane like covering of the eye, and isolating one or more of the eye muscles that move the eyes in various directions. No incision is made on the skin. The eye is not pulled out of the socket. The eye is gently moved no more than one normally moves the eye when looking around. The incision is almost always made behind the eyelid so the incision itself is usually not visible unless one pulls the eyelid back.
Strabismus surgery usually takes 20-40 minutes. General anesthesia is used. There is always a very slight risk of death or some other serious complication, but the risk is very small, about 1 in 20,000 cases.
You will have an opportunity to talk with a member of the anesthesia team, usually one of the anesthesiologists, the morning of the surgery. Patients under age eight or nine years of age are usually "put to sleep" while breathing through a mask. After the patient is "asleep" from the anesthesia, an IV is started to give fluids and medications. In patients over nine years, usually an IV is begun before the patient is asleep and the patient is "put to sleep" with medication given through the IV. Sometimes several "sticks" are needed before an IV is successfully started. The IV "sticks" will leave a small mark in the skin that usually heals completely in a few days.
It is important that the person undergoing surgery does not eat or drink anything after midnight the day prior to the surgery. Sometimes infants under age 1 year can drink milk or liquids until 4-6 hours before the surgery. The patient or the family will be called the day before surgery and informed when oral intake of all sorts should stop.
If the patient is taking any medications regularly, you should ask whether these medications should be taken the morning of the surgery. Most medications are not given until after the surgery but essential medications (for example, for seizures or high blood pressure) can be taken the morning of surgery with a small sip of water.
The success of the surgery is dependent on the ability of the eyes to work together as a team, or the ability of the patient to FUSE or combine the image from each eye successfully into a single image. On average, one eye muscle operation has about an 80% success rate. Another operation may be needed a few weeks, a few months or a few years following the initial surgery.
If the patient has an eye muscle problem that is intermittent rather than constant, the chances of success are usually better than if one of the eyes deviates constantly. If extremely poor vision is present in one or both eyes, the chance of one operation being successful permanently is generally somewhat lower.
The surgery is almost always performed as "Day Surgery": that is, the patient comes into the hospital or day surgery facility the morning of the surgery and goes home the same day. Almost all patients can leave the hospital the same day the surgery is performed.
VISION AND SURGERY:
The risk of losing vision from the surgery is extremely small, about 1 in 20,000 or less. If the patient wears glasses, there may be a small change in the prescription following surgery. It is usually best to wait six weeks following surgery to change the prescription in the glasses.
What about glasses? If you or your child wears glasses prior to eye muscle surgery, glasses will probably (not always) be needed after surgery. If you or your child does not wear glasses prior to surgery, glasses may be needed after surgery to help keep the eyes working together. If prisms are worn in the glasses, then a pair of glasses without prisms should be obtained prior to surgery to be used immediately following surgery.
POST OP STRABISMUS SURGERY:
The amount of pain following surgery is variable. Some very young patients wake up with very little pain. Generally, a child with have some soreness in the eyes for 1-3 hours, during which time a cool rag on the eyes is helpful. All patients over age 2 years will receive one medication to prevent pain and one medication to prevent nausea in the IV during surgery. Usually these medications prevent much of the pain and nausea that once followed eye muscle surgery.
After 1-3 hours, the eyes are usually not extremely sore. There may be a foreign body sensation, like having an eyelash in the eye that may persist for 2-4 days.
The eyes normally stay red for 1-2 weeks or sometimes more following eye muscle surgery. If the redness in the eyes increases markedly, or if the eyelids become red and swollen, an infection on the outer surface of the eye may be present Antibiotics by mouth may be required.
Usually a change in the position of the eyes will be noted soon after surgery, but the final effect cannot be completely assessed for four to six weeks after the surgery.
STRABISMUS SURGERY IN THE U.S. AND WORLDWIDE:
Eye muscle surgery has become a highly skilled procedure that is often successful in restoring binocular vision. This surgery has only been used widely across the United States over the last 50-60 years and is still only rarely done in many parts of the world. We are very fortunate to live in a country that has been the pioneer of this type of surgery that has been extremely beneficial in improving the appearance and the function of so many of its citizens.
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