Lazy Eye Surgery

9 sources cited
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What Causes a Lazy Eye? 

Amblyopia, or, lazy eye, is a condition in which someone has poor vision in one eye. Approximately 2 to 4 percent of the U.S. population has this condition. 

In amblyopia, the brain fails to coordinate nerve signals from the affected eye. This causes it to rely on the stronger eye and stop using the weaker one.

A lazy eye can develop until late childhood. Risk factors for this condition include premature birth, a family history of other eye conditions, and developmental disabilities. 

Symptoms of amblyopia include:

  • Squinting
  • Shutting one eye
  • Head tilting
  • Poor depth perception

Eye conditions that can cause amblyopia include:

  • Nearsightedness
  • Farsightedness
  • Astigmatism
  • Strabismus (eye misalignment when looking at an object)
  • Cataract 

Do You Need to Correct a Lazy Eye?

It’s necessary to correct a lazy eye as soon as possible. A person can become functionally blind and suffer from lifelong vision loss if the condition isn’t treated. Functional blindness requires using supportive techniques to perform daily tasks like reading or walking.

An eye exam is the only way to determine if someone has amblyopia. Parents should bring their children to the doctor for their first vision screening once they are between 3 and 5 years old.

Treatment is more effective in children, so doctors advise parents to bring their kids in for routine checkups every year. Early detection is key as the condition is more challenging to treat once children turn 6.

Vision typically improves in just a few weeks after treatment. However, it can take months for vision to correct completely. Doctors will also recommend additional treatments to prevent the lazy eye from coming back.

How Does a Lazy Eye Affect Vision?

Amblyopia affects the visual function of the affected eye in several ways. It can:

  • Cause blurry vision
  • Reduce eye movements
  • Affect depth perception
  • Impair reading abilities

Doctors often recommend surgery if a child is born with cataracts, a condition that causes cloudy vision in one or both eyes. Surgery is also typically necessary if a child has strabismus, the misalignment of both eyes.

Lazy Eye Surgery: What to Expect 

The surgical treatments available to people with amblyopia don’t directly address the condition. Instead, they fix possible underlying causes like:

  • Strabismus
  • Droopy eyelids
  • Corneal scars
  • Cataracts

Strabismus surgery is one of the most common procedures for amblyopia. It repairs the muscles responsible for keeping the eyes aligned. It also weakens or strengthens them to change the position of the lazy eye.

Doctors generally don’t recommend surgical procedures for adults. If they do, it’s usually for cosmetic reasons and to improve depth perception. Lazy eye surgery is generally more common and effective in children.

Before Surgery

Before getting lazy eye surgery, a person should consult their primary care doctor and the doctor who will perform the surgery. They can provide critical care information about pre- and post-surgery healing. 

Before surgery, you will also undergo preoperative testing that includes:

  • Blood tests
  • Urine tests
  • Chest X-rays
  • EKGs

These tests are necessary for the anesthesiologist to refer to during the surgery. You will also need to share information about any allergies, current medications, and family health history with the doctor.

Doctors cannot perform surgery if you’re experiencing:

  • Upper respiratory congestion
  • Cough
  • Sore throat
  • Vomiting
  • Diarrhea
  • Fever

Children cannot take aspirin or ibuprofen 2 weeks before the surgery. They should also avoid vaccinations of any kind a day before the procedure.

Infants and children under 13 years of age can eat solid foods up to 8 hours before the surgery. Breast milk and clear liquids are allowed until 4 hours and 2 hours, respectively, before surgery.

Adolescents and adults can’t have anything to eat or drink at least 8 hours before the procedure. They should also stop taking any medications 2 hours before.

A child’s parent or guardian will need to sign a consent form. They will also have to stay in the waiting area during the procedure.

During Surgery

The surgery takes approximately 45 minutes to 2 hours under general anesthesia. The duration depends on the type of surgery and whether one or both eyes need correction.

During the procedure, an eyelid speculum holds the eye open. This allows the surgeon to make a small incision on the membrane covering the whites of the eye. They will either detach or reattach the muscles to the eye through this opening.

The surgeon will then close the incision with stitches that dissolve on their own. Adults might need adjustable sutures, which shorten or lengthen the muscle for further alignment within 24 hours after surgery.

After Surgery 

Recovering from anesthesia can take several hours. If the surgeon needs to make any adjustments post-op, they will apply numbing eye drops. 

After the adjustment, the doctor will prescribe antibiotics and steroid drops to prevent infection and treat inflammation. They may also prescribe drops to dilate the pupil.

It takes the eye 6 weeks to fully heal. Postoperative checkups are required a day after the procedure. The second checkup is due 5 days after surgery, and the third is after 4 to 6 weeks. 

Children and adults can return to normal daily activities within a few days after surgery. However, for at least 2 weeks, children and/or adults should avoid:

  • Contact sports
  • Swimming in pools or lakes
  • Eye makeup
  • Playing in sandboxes
  • Driving
  • Operating heavy equipment

The doctor can assess the procedure’s success once the eye heals completely. 

Side Effects and Risks of Lazy Eye Surgery

After surgery, the eye can feel sore and appear red. Other common side effects include:

  • Light sensitivity
  • Itchiness
  • Mild pain
  • Discharge
  • Matting of lashes
  • Double vision

These symptoms can last from 2 days to a few weeks, depending on the person’s recovery speed.

More severe side effects that can be a cause for concern include:

  • Green or yellow discharge
  • Vision loss
  • Worsening pain
  • Increased swelling
  • High fever
  • Nausea and/or vomiting

Call your doctor immediately if you notice these symptoms within the first week after surgery. This is a common time for infections and problems to occur.

Other serious but less common complications of lazy eye surgery include bleeding, muscle detachment, and scarring. 

Risks associated with surgery for amblyopia include:

  • Needing glasses indefinitely to see properly
  • Recurrence of strabismus
  • Partial or complete failure of the procedure

If strabismus recurs or the procedure fails, additional surgery will be required to address the issue.

Is Lazy Eye Surgery Worth It?

Surgery does not directly address the cause of amblyopia, but it can be part of the solution for this complex condition.

Benefits of this procedure include:

  • Improved physical appearance
  • Reduced eye strain and/or fatigue
  • Better functionality between the eyes and other facial structures
  • Less difficulties during lazy eye therapy
  • Enhanced depth perception

Adjusting the eye muscle can make correcting a lazy eye easier. However, people also risk:

  • Recurrence of strabismus
  • Double vision
  • Infection
  • Needing glasses to see properly

Whether or not to get lazy eye surgery should be further discussed with your doctor. It’s essential to examine the benefits and potential risks before opting for surgery.

Summary

  • Lazy eye, also called amblyopia, is a condition caused by poor nerve coordination between the brain and the eyes
  • Amblyopia can develop early on in children until late childhood
  • Amblyopia treatment is more effective in children than adults
  • Doctors will likely recommend surgical treatment if a child was born with cataracts or develops strabismus
  • Adults who undergo lazy eye surgery typically do so for aesthetic benefits and to improve their depth perception 
  • Doctors typically recommend non-surgical treatments like corrective lenses, eye patches, or atropine eye drops before lazy eye surgery

Surgical treatment for amblyopia doesn’t address the disconnect between the brain and the eye. However, it can supplement other lazy eye treatments.

Amblyopia surgery risks include partial or complete failure. Some people might also need to wear glasses indefinitely to see correctly.

Before deciding whether or not to get this procedure, discuss the potential risks and benefits with a doctor.

9 Cited Research Articles
  1. After Surgery – Postoperative Expectations for Strabismus Surgery.” ABC Eyes Pediatric Ophthalmology PA, Pediatric Ophthalmology P.A
  2. Amblyopia (Lazy Eye).” National Eye Institute, National Institutes of Health, 2 July 2019
  3. Beauchamp, GR. “Risks, Benefits, Limitations and Alternatives to Strabismus Surgery.” ABC Eyes Pediatric Ophthalmology PA, Pediatric Ophthalmology P.A
  4. Beauchamp, GR. “What to Expect Before Strabismus (Eye Muscle) Surgery.” ABC Eyes Pediatric Ophthalmology PA, Pediatric Ophthalmology P.A
  5. Eye Muscle Surgery.” UPMC Children’s Hospital of Pittsburgh, UPMC
  6. Kuwera, E. “Lazy Eye (Amblyopia).” Johns Hopkins Medicine, The Johns Hopkins University and The Johns Hopkins Hospital and Johns Hopkins Health System, 
  7. Overview – Lazy eye.” NHS, Crown, 16 May 2019
  8. Surgery for Lazy Eye.” NYU Langone Health, NYU Langone HospitalsTreatment – Lazy eye.” NHS, Crown, 16 May 2019
  9. Treatment – Lazy eye.” NHS, Crown, 16 May 2019
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