Strabismus repair is a common surgical procedure aimed at correcting misaligned eyes. The goal of the surgery is to help the eyes work together more effectively, which can also address cosmetic concerns.
Understanding Strabismus
Strabismus is a condition where both eyes do not look in the same direction at the same time. This misalignment can manifest as crossed eyes (esotropia), outward-turning eyes (exotropia), or one eye turning upward (hypertropia) or downward (hypotropia). Up to five percent of the population experiences strabismus, which can affect both children and adults. In a healthy visual system, six muscles attached to each eye work in coordination, receiving signals from the brain to direct eye movements and ensure both eyes point at the same target.
When these muscles or the nerves controlling them do not function correctly, or when there are issues with the brain’s control center for eye movements, strabismus can develop. Common causes include muscle imbalances, nerve problems, or underlying vision issues like significant uncorrected farsightedness. If left untreated, strabismus can lead to complications such as double vision, reduced depth perception, eye strain, headaches, and in children, amblyopia, also known as “lazy eye,” where the brain ignores the image from the misaligned eye.
How Strabismus Repair Works
Strabismus repair involves adjusting the six extraocular muscles surrounding each eye to rebalance them and achieve proper alignment. This is typically performed under general anesthesia, ensuring the patient is unconscious and experiences no pain during the surgery.
Two primary techniques are used to adjust the eye muscles: recession and resection. In a recession procedure, a muscle that is too strong is detached from its original insertion point and reattached further back, weakening its pulling power. Conversely, a resection procedure strengthens a weak muscle by removing a small section and reattaching the shortened muscle to its original position, increasing its tension.
In some cases, particularly for adults, adjustable sutures may be used. With this technique, the surgeon places a special knot that can be tightened or loosened after the initial surgery, usually within 24 hours. This allows for fine-tuning of the eye’s alignment while the patient is awake, often with topical anesthetic drops. Once optimal alignment is achieved, the adjustable suture is permanently secured.
Preparing for and Recovering From Surgery
Preparation for strabismus surgery involves several steps:
- Undergoing a comprehensive eye examination to measure misalignment and assess muscle function.
- A medical history review, including discussions about current medications and prior eye surgeries.
- Receiving specific pre-operative instructions, such as fasting and adjusting certain medications like blood thinners.
- Arranging for someone to drive you home after surgery and assist with initial recovery.
Immediately following surgery, patients are monitored in a recovery room until they are ready to go home. Common side effects include mild discomfort, redness, and swelling around the eyes, which usually subside within the first week. The eyes may also feel scratchy or gritty, and temporary double vision can occur as the brain adjusts to the new alignment. Pain management typically involves prescribed eye drops or ointment, and over-the-counter pain relievers may be recommended.
Activity restrictions are important for proper healing and to prevent complications. Patients should avoid rubbing their eyes and refrain from swimming for two to four weeks to reduce infection risk. Strenuous activities and contact sports should be avoided for six to eight weeks. While many patients can resume light activities like desk work within a week, complete recovery typically takes four to six weeks. Contact the eye care provider if severe pain, excessive swelling or discharge, persistent double vision, or signs of infection like fever occur.
Long-Term Outlook
The long-term outlook following strabismus repair is positive, with a high success rate in achieving improved eye alignment. Strabismus surgery is effective in 80-90% of cases for satisfactory alignment with one procedure. Many patients report improved vision, including enhanced depth perception and reduced eye strain. The cosmetic improvement from corrected eye alignment can also boost confidence.
Despite high initial success rates, some patients may require further surgical intervention, especially in cases of large angle strabismus or certain types of misalignment. Reoperation rates vary, but some patients may need additional procedures.
Follow-up appointments are a regular part of post-operative care for monitoring healing and eye alignment. These visits allow the ophthalmologist to assess recovery, measure any remaining misalignment, and adjust treatment if necessary. While surgery corrects physical alignment, vision therapy may be recommended to help the eyes work together and improve coordination. The brain’s adaptation to the new eye alignment can continue for several months, with optimal binocular vision developing over six to twelve months post-surgery.