Strabismus surgery is an attempt to realign eyes as close to normal as possible. However, a child’s eyes will never perfectly align and an adult can only expect to achieve near perfect alignment and benefit from improved depth perception and field of view. Surgery will not correct the poor vision that results from amblyopia because the amblyopia involves an underdevelopment of the portion of the child’s brain that is responsible for vision.

Strabismus surgery involves either a recession or resection of eye muscles. Recession is a weakening of eye muscles. The procedure involves detaching one of the six muscles attached to the eye and a reattachment of that muscle further to the back of the eye. In contrast, resection is a strengthening of eye muscles. The surgical procedure involves detaching one of the eye muscles, removing a portion of the muscle from the distal end of the muscle and reattaching the muscle to the eye. As a result of surgery, most patients are expected to experience some form of straitening that positions their eyes in the forward direction. Other patients may need additional surgery.

The surgical procedure for children with Exotropic (outward) Strabismus involves a weakening of the outside (lateral rectus) muscles. In some instances, this recession may need to be complemented with a resection of the inside (media rectus) muscles. For children with Strabismus and who have not developed Amblyopia, surgery is typically necessitated. It is expected that with age, a child will benefit from improved depth perception. The typical surgery for Esotropic Strabismus is muscle recession of the inner eye. Surgery may be required for one or both eyes. In some instances, the recession is complemented by a resection of the muscles of the outer eye. The typical surgical procedure for Hypertropic Strabismus involves a weakening of the deviated muscle and a repositioning of other muscles on the eye.

A proper diagnosis by a surgeon trained in treating adults with Strabismus will determine whether it is possible or appropriate to attempt to straighten the eyes of an adult. Adults can expect to gain some type of improvement in binocularity, which is two eyes working together. Adults that acquire Strabismus as a result of some other medical condition and who also suffer double vision prior to surgery may expect to continue to have double vision problems following surgery. Some of these patients may get relief from double vision with additional forms of Strabismus treatment, such as glasses, prisms or medication. Adults that acquire Strabismus as a result of no treatment or unsuccessful treatment during child hood may experience double vision for only a period of weeks.

The level of success or complications from Strabismus surgery varies from individual to individual. The most severe complications may include retinal detachment or Endophthalmitis, which is inflammation of the eyeball. These complications are rare and result from an accidental perforation of the eye globe during surgery. Other complications that are typical for any surgical procedure, such as infection, bleeding and scarring may also result. Some discomfort may be experienced from the sensation of foreign bodies in the eye. Strabismus surgery is usually performed as an outpatient procedure, but patients in poor health may require hospitalization. Recovery is typically within days of the surgery.

On this blog you can see how the eyes look like in the days after Strabismus surgery, in an infant. | Courtesy: JRS