Six eye muscles move each eye. Strabismus means the eyes are misaligned. The eye muscles can be tightened or loosened to improve the alignment of the eyes. Strabismus surgery can be performed if glasses do not correct the misalignment. Eye muscle surgeries are restorative, and may do much to improve visual function, social interaction and self esteem. It is not normal to have misaligned eyes.
In children, strabismus surgery may decrease the chance ongoing amblyopia, but glasses and patching may still be required. The secondary aim of strabismus surgery is improve the patient's appearance.
The most important objective of strabismus surgery is to improve the alignment when the patient is looking straight ahead. Even after surgery, patients with complex strabismus may not see single when looking in eccentric positions of gaze. Some patients may see double when looking straight ahead for the first few weeks following surgery, but this usually improves as the eyes learn to work together again. Surgery may not eliminate double vision when you look off to the side, up or down.
Before surgery
STOP ASPIRIN, ADVIL, VITAMIN E, GINGKO BILOBA and other blood thinners IF possible. If you take aspirin, consider stopping it for 10 days prior to your surgery, IF agreeable with your family doctor/internist. (If you take pradax, xarelto, coumadin or plavix, consult with your family doctor or internist before stopping it. Tylenol (acetaminophen) can be used for pain relief without increasing your bleeding tendency. You can usually restart your aspirin or advil 1-2 days after surgery.
DO NOT EAT OR DRINK STARTING AT MIDNIGHT BEFORE YOUR SURGERY. You can take prescription medications with a sip of water. Diabetics should NOT take their diabetes pills the morning of surgery, and use at most half their normal insulin dose. ARRIVE 2 HOURS BEFORE THE SCHEDULED SURGERY TIME. Arrange to HAVE FAMILY/A FRIEND pick you up after the SURGERY. A few patients have marked nausea after surgery, despite being given prophylactic medication after surgery. Just in case bring towels or plastic bag for the car ride home.
After surgery care
- YOUR EYE/EYELID MAY APPEAR RED, BRUISED AND PUFFY FOR MANY WEEKS. To decrease swelling you can place a cool cloth on the eye(s) that were operated on through the closed eyelid. Cold compresses can be made by dipping a clean cloth or tissue in ice water, or by placing some frozen peas in a plastic bag.
- A patch is usually not required.
- You need to put antibiotic drops (e.g. Tobradex) in the operated eye(s) 2-4 times a day, for 7-10 days.
- It is common to have your eye(s) feel itchy, scratchy, gritty, dry or even watery after surgery. If this happens use over-the-counter lubricating drops or ointment (e.g. Refresh liquigel or Celluvisc) in your eye 4-6 times per day, and you will feel better. You can do light work the day after surgery, and children can usually attend school within a few days.
- WASH YOUR HANDS. Avoid dusty, dirty environments for the first week.
- You can take showers with your eyes closed right after surgery, but no swimming.
- Do not let the family pet lick your face.
- Do not touch your mouth and then touch your eye.
- Glasses may be required after strabismus surgery, especially if the patient wore them before the surgery. Wearing the proper glasses prescription will decrease the chance of long term drift of poorly seeing eyes.
- Depending on your particular operation, you will have a follow up appointment in the office in 1-6 weeks.
- MORE THAN ONE OPERATION MAY BE REQUIRED. To minimize scarring and overcorrections, it is better to err on the side of doing less surgery than too much surgery. Repeat operations are more common for large deviations, patients with poor vision and cerebral palsy patients. It is not uncommon for strabismus to recur over time.
EMERGENCIES: If you cannot reach Dr. Strungaru through her office, go to your nearest emergency room. If Dr. Strungaru is not on call, one of the other ophthalmologists will be covering urgent eye problems that come through the emergency room.
RISKS of strabismus surgery
- uncontrolled bleeding
- infection
- vision loss/blindness (risk < 1 in 20,000),
- persistent eye irritation,
- double vision
- reoccurrence. It is not uncommon for the eyes to become crooked again with time, following strabismus surgery, especially in poorly seeing eyes.
- Anesthetic complications. Rarely patients may develop a severe allergic reaction to the anesthetic. Strokes and death are extremely rare complications of ophthalmic surgery (risk < 1 in 20,000)