Strabismus Surgery

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What is Strabismus Surgery?

Strabismus surgery is a common treatment approach for an eye disease called strabismus. When individuals have strabismus, their eyes do not line up correctly because of weak eye muscles or a problem with the nerves that control the eye muscles. As a result, those with strabismus have the appearance of a wandering eye and lose binocular vision. 

In strabismus surgery, ophthalmologists manipulate muscles around the eye by either loosening, tightening, or repositioning to improve the alignment of the eyes and vision. While this type of surgery is successful in many cases, some individuals may need to undergo another surgery within 3 to 6 months of the initial procedure. 

Strabismus Surgery

Ophthalmologists generally perform the procedure on adults on an outpatient basis, using local anesthesia. For children, ophthalmologists will use general anesthesia. The severity of the condition will determine if work on both eyes is necessary. 

After strabismus surgery, individuals can expect to experience some discomfort. This should not prevent individuals from returning to their normal activities within a week or even less. 

Many people sometimes confuse strabismus with amblyopia (otherwise known as “lazy eye”). While it is possible to correct strabismus, amblyopia is difficult to treat in adults. 

Indicators for Strabismus (Eye Muscle) Surgery

Strabismus surgery may be ideal for individuals who experience the following symptoms:

  • Misaligned eyes
  • Weakness surrounding the eye or a pulling sensation around the eyes
  • Double vision (viewing two of one picture)
  • Blurry vision
  • Difficulty reading 
  • Loss of depth perception
  • A need to tilt or turn the head to view an image better

Eye Muscle Surgery: Step-By-Step

Here is a step-by-step rundown of the eye muscle surgery:

  • A pre-operative eye exam is performed 1 to 2 days before the surgery in an ophthalmology clinic 
  • On the day of surgery, anesthesia (local or general) will be administered
  • An ophthalmologist will then hold the eyelids open with a lid speculum 
  • An incision is made into the conjunctiva (thin, transparent tissue membrane on the white part of the eyeball)
  • The muscles in question are then isolated and repositioned according to the direction the eye is turning
  • In cases of recession (to weaken the muscle), the muscle must be moved further back 
  • In cases of resection (to strengthen the muscle), the muscle must be shortened and reattached to the eye
  • In cases of an adjustable suture, an accessible bow-knot or slip-knot (temporary knot) is used instead of a permanent knot to anticipate a possible need to readjust eye alignment in a postoperative session

How Long Does Strabismus Surgery Take?

Strabismus surgery duration will vary from one individual to the next, depending on many factors. It can be as little as thirty minutes to as much as two hours. In general, though, eye muscle operations of this kind last for approximately an hour once the actual surgery has started. 

It is important to mention that if an individual is administered general anesthesia, it may take a few hours after surgery for its effect to wear off. Nausea may also occur, delaying a discharge by about an hour or two. 

In any case, it is best to wait for the eye doctor to perform a postoperative check-up before leaving the eye care center. 

What to Expect After Strabismus Surgery 

When an individual undergoes strabismus surgery, an eye surgeon may decide to administer local anesthetic or general anesthesia. In adults, local anesthesia is standard. However, if individuals request general anesthesia, a few hours must pass after surgery before the effect diminishes. 

The individual who received the surgical treatment may also receive post-op eye drops, which typically includes an antibiotic and steroid. This type of medication helps to prevent infection and reduce scarring during the healing process. 

When the ophthalmologist signs the discharge papers, individuals should take it easy for the following days and respect specific advice. For example, individuals should not do the following:

  • Swim in pools for five days 
  • Drive (mainly if the operation was performed on the dominant eye or double vision was present)
  • Wear contact lenses immediately afterward

Like any surgery, the more extensive it is, the longer the healing period. This means that it may take adults up to seven days to begin feeling comfortable. The eyelids may also be swollen and make it challenging to open the eye shortly after surgery. Additionally, the eyes will continue being red for another 1 to 2 weeks. The pinkness in the eye(s) may not reside for several months. 

Strabismus Surgery Cost

Strabismus surgery costs will vary from one healthcare facility to another. The following will be considered when calculating the final price:

  • Surgeon and surgical assistant fees
  • Anesthesiologist fees
  • Facility, equipment, and service charges (including anesthesia and supplies)

Fortunately, because strabismus is a medical eye condition that results in a functional disability, most insurance companies cover the eye muscle surgical procedure. Pre-authorization may be necessary in some cases, but it is highly uncommon for an insurance company to deny a request for this type of surgery. 

Strabismus surgery is not cosmetic surgery. Individuals with strabismus cannot correctly see and experience a functional disability. 

What kind of anesthesia is used for strabismus surgery?

Patient age, health, and preference will determine what type of anesthesia is used in the surgical procedure. Adults may undergo surgery with general anesthesia or remain awake yet sedated with local anesthesia. In most cases, ophthalmologists perform the surgery on an outpatient basis. 

Is strabismus surgery safe?

In general, yes. However, like any type of surgery, there are some risks.

When anesthesia is administered, there are some risks, such as death, altered brain function, or pneumonia. Loss of vision may also result from the use of anesthesia, and the overall surgical procedure may lead to retinal detachment, bleeding, infection, or a change in blood supply to the eye. 

However, these types of complications are very rare.

Similarly, other minor risks consist of a scratch on the cornea, inflammation of the conjunctiva (eye surface membrane), pain, and scar tissue in some cases. 

Is strabismus surgery painful?

This type of surgery is not excessively painful. After the procedure, there will be discomfort and soreness, especially when moving the eye(s). Redness of the eyes will occur and may take up to several weeks before it resides.

What is the success rate of strabismus surgery?

The success rate of strabismus surgery depends on how complicated the case is. In general, approximately 10 to 20% of individuals will need to undergo additional surgery to correct a muscle that could not fully adhere to the new position. 

Does strabismus surgery improve vision?

Yes. In most cases, strabismus surgery helps to correct eye alignment and restore good vision. 

Resources
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“Adults with Strabismus Service: FAQ: Boston Children's Hospital.” Boston Children's Hospital, www.childrenshospital.org/centers-and-services/programs/a-_-e/adults-with-strabismus-service-program/q-and-a-with-dr-david-hunter.

Boyd, Kierstan. “Adult Strabismus Treatment.” American Academy of Ophthalmology, 29 May 2020, www.aao.org/eye-health/diseases/strabismus-treatment.

“Strabismus Surgery.” Strabismus Surgery - American Association for Pediatric Ophthalmology and Strabismus, https://aapos.org/glossary/strabismus-surgery.

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