Strabismus surgery is surgery on the extraocular muscles to correct misalignment of the eyes. It is performed when other treatments have failed or are not appropriate. Strabismus surgery is performed as a day procedure.
In babies with infantile esotropia, early surgery is recommended to restore or promote normal binocular vision. In older children timing depends on a number of factors including vision, compliance with glasses, if worn and stability of the strabismus angle.
In adults, eye alignment surgery is not considered ‘cosmetic’ but ‘reconstructive’ as it not only restores normal appearance but improves depth perception or binocular vision, visual fields, eliminates double vision and improves social function.
It is important to discuss your goals and expectations of the surgery.
How is strabismus surgery performed?
Strabismus surgery in children requires general anesthesia. In adults, the procedure can be done with general or local anesthesia.
The eyelids are gently held open with a lid speculum. A small opening is made through the conjunctiva to access the muscles which are attached to the outer white coat (sclera) of the eye by tendons.
One or more of the eye muscles are ‘strengthened’ (resection), ‘weakened’ (recession) or moved to a different position to improve alignment (transposition) with dissolvable sutures. Most strabismus surgeries take 1-2 hours.
In standard strabismus surgery, the muscle is reattached to the eyeball in the new position with a suture which is tied off with a permanent knot. In adults, there is the option of an ‘adjustable’ suture. Instead of a permanent knot, a temporary knot is placed. After the surgery, with the patient awake, alignment can be reassessed, and if necessary, an adjustment can be made to change the muscle position.
Adjustment allows fine tuning of the surgery to minimize the chance of an over-correction or under-correction. This is typically done the day of or the day after the surgery.
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