Strabismus Surgery

Strabismus surgery is eye muscle surgery to treat misaligned eyes (strabismus). A surgeon will tighten or loosen the muscles in your eye. This will help your eyes stay centered and work together better.

Eye muscle surgery can treat any kind of strabismus, including:

• Exotropia
• Esotropia
• Hypertropia
• Hypotropia

You might need this surgery after a stroke. It can also improve nystagmus or other types of uncontrollable eye movements.

Types of strabismus surgery

There are a few ways your surgeon can change your eye muscles with strabismus surgery:

• Resection is the medical term for tightening a muscle by removing some of it.
• Plication is tightening a muscle by folding it over back on itself.
• Recession is weakening a muscle to make it looser.

Your surgeon will change the length or position of your eye muscles. What you need will depend on which type of strabismus you have or why your eyes are out of alignment. They might change more than one muscle during surgery.

How should I prepare for this procedure?

Your surgery care team will help you prepare before your surgery date. They’ll ask about:

• Your health history, including any previous eye surgeries you’ve had
• Which medications and supplements you take, especially any blood thinners
• If you’ve ever had a bad reaction to anesthesia in the past

You’ll also need a dilated eye exam to make sure it’s safe for you to have surgery.

Your care team will tell you if you need to stop taking any medications or supplements before surgery. They’ll also let you know when you should stop eating and drinking before your surgery appointment. That’s usually at midnight the night before, but it can vary.

Make sure to arrange transportation to and from your surgery appointment. You won’t be able to drive yourself home. And you won’t be able to drive for a week or two after surgery. It can be helpful to make plans ahead of time so you’re not trying to figure everything out while you’re recovering.

What happens during strabismus surgery?

An anesthesiologist will give you anesthesia to make sure you don’t feel pain during the surgery. They might use general anesthesia so you sleep through the procedure. Or they may give you a combination of eye numbing and light sedation.

The steps of strabismus surgery can vary depending on how your surgeon needs to change your eye muscles. But in general, your surgeon will:

1. Use a device called an eye speculum to hold your eyelids open.
2. Cut into the white part of your eye (conjunctiva) to access your eye muscles.
3. Use a hook to gently pull up the muscles that need surgery.
4. Cut or move the muscles as needed.
5. Reattach the muscles and close your eye with dissolvable stitches.
6. Remove the speculum and put eye drops or ointment into your eye.

How long does this procedure take?

Strabismus surgery usually takes between 30 minutes and two hours. Your surgeon can tell you what to expect before your appointment.

What are the potential benefits and risks of this procedure?

Strabismus surgery can improve the way your eyes work together to create your 3D vision. This is especially true for children.

Strabismus surgery can also change your physical appearance. Lots of people say this helps them feel more confident.

Like any surgery, there are some risks, including:

• Infections
• Bleeding
• Scarring
• Developing double vision or drooping eyelids (this is usually temporary)
• Your eyes falling out of alignment again (recurrent misalignment)

What happens after strabismus surgery?

Your care team will move you to a recovery room after surgery. They’ll help you manage any pain and make sure you come out of anesthesia without any complications. You’ll be able to go home the same day.

Your surgeon will prescribe eye drops or ointment for you to take at home. Your care team will show you how to apply them. They’ll also give you a pain management plan. You may only need over-the-counter pain relievers. Your care team will tell you which medicines are best and how often it’s safe to take them.

What is the recovery time?

You’ll need anywhere from a few days to a couple of weeks to rest after your surgery.

Your eyes may be red and feel sore or scratchy for a few weeks. It will take two to three months for them to heal completely.

You may have double vision for a few days after strabismus surgery. It can take longer than that for some people. Don’t resume driving until your surgeon says it’s safe.

Plus, don’t go into swimming pools, saunas or hot tubs for two weeks after the procedure. This helps prevent infections.

The stitches in your eye will dissolve on their own. Your body will safely absorb them. This can take up to six weeks.

Will I still need to wear my glasses after strabismus surgery?

Yes, you’ll still need glasses or contacts if you needed them before surgery. Strabismus surgery realigns your eyes. But it won’t correct the kinds of refractive errors that cause blurry vision. Your glasses prescription probably won’t change after surgery.

If you wear glasses with prisms before surgery, you won’t need prisms after.

When should I call my healthcare provider?

Contact your surgery care team if you have:

• Eye pain that gets worse, even after taking medicine
• Worsening vision
• Your eye is drifting significantly in the opposite direction
• Signs of infection, like a fever, eye discharge, increased redness in the whites of your eyes, or swelling and skin discoloration in your eyelid
• A growth of scar tissue or a discolored bump
• Any symptom that worries you