What to Expect Before, During, and After Strabismus Surgery

Sometimes you might notice that a child's or an adult's eyes do not point in the same direction. People often call this condition a crossed eye or a wandering eye. When one eye looks straight while the other turns in a different direction, it can sometimes feel a bit awkward or stressful in social settings.

However, this is a very common medical condition that doctors can treat successfully. One of the main and most effective treatments is an eye muscle operation. Today, we will talk all about this procedure, which doctors call strabismus surgery.

What is Strabismus Surgery?

Strabismus surgery is an operation on your eye muscles designed to straighten your eyes. The goal is to get both eyes pointing in the exact same direction. Tiny muscles on the outside of your eyeball control how your eye moves up, down, left, and right.

During this surgery, your doctor will either make a muscle slightly tighter or a bit looser. These small adjustments change the pull on your eyeball so your eyes can look straight ahead together. It does not involve lasers inside your eye or touching your actual vision pathways.

Who Needs This Surgery?

About 5 percent of people around the world experience some form of eye misalignment. If your eyes are not aligned properly and other treatments like special glasses or eye patches do not fix it, your eye doctor may suggest surgery. While doctors perform this procedure often on young children, adults can benefit from it just as much.

You might need this surgery if you have one of the following eye alignment conditions:

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Types of Strabismus Procedures

Doctors can perform this surgery on one eye or on both eyes. When surgeons operate on both eyes, they call it bilateral strabismus surgery. Your surgeon uses specific techniques to modify your eye muscles depending on your exact needs.

• Resection: The surgeon removes a very small piece of the eye muscle to make it shorter. This tightens the muscle and pulls your eye further in that direction.
• Plication: Another way to shorten the muscle without cutting out a piece. The surgeon folds the muscle and places a stitch to hold it tight.
• Recession: The surgeon detaches the eye muscle from its spot on the eyeball and reattaches it further back. This loosens the muscle's pull so your eye turns the other way.

What Happens Before Surgery?

Before your operation date, your eye doctor will review several important details with you to make sure you are ready.

• Your doctor will review your complete medical history, including past health conditions and previous operations.
• If you have had eye muscle surgeries in the past, your surgeon will need your old operative reports.
• Tell your doctor about every medicine and supplement you take. You must mention any blood thinners right away.
• Share if you or anyone in your family has ever had a bad reaction to anesthesia (sleep medicine).
• Let your medical team know if you have any known allergies to medicines.

A few days before your surgery, you will meet with an anesthesia doctor. They will tell you when to stop eating and drinking. Usually, you must not eat or drink anything after midnight on the night before your procedure. They may also tell you to pause certain regular medicines for a few days.

On the day of your surgery, your care team will examine your eyes one last time. This confirms the exact muscles they need to adjust.

What Happens During Surgery?

You can feel reassured that strabismus surgery is a very safe and routine procedure. Here is what happens step by step:

1. Your nurse places a small plastic tube in your arm to give you fluids and medicine through an IV line.

2. All children and most adults receive general anesthesia. This means you will sleep soundly through the entire operation and feel zero pain. For certain adults, doctors may use local numbing medicine with mild calming medicine.

3. Your surgical team continuously monitors your vital signs, such as your heart rate and breathing.

4. The surgeon places a tiny instrument called a lid speculum to keep your eyelids gently open during the procedure.

5. Next, the surgeon makes a very small incision in the conjunctiva, which is the clear, thin tissue covering the white of your eye.

6. Using a small surgical hook, the surgeon lifts the target muscle and adjusts it by tightening or loosening it as planned.

7. Once the muscle is in the correct position, the surgeon secures it using tiny stitches that dissolve on their own over time. Then they close the small tissue opening.

8. Finally, they remove the eyelid tool and place soothing eye drops or ointment in your eye.

The entire operation usually takes anywhere from 30 minutes to 2 hours.

What Happens After Surgery?

After your operation, your care team moves you to a recovery room. They watch over you closely until you wake up fully and are ready to go home.

• A responsible adult must take you home. Your care team will advise that someone stays with you for the first 24 hours.
• Plan to rest and take it easy at home for a few days up to a full week. Avoid heavy work or straining.
• Use your prescribed eye drops or ointment strictly as directed by your doctor.
• You can take over-the-counter pain relievers like Paracetamol if you have mild soreness.
• Always ask your doctor what signs to watch for and when you should call their office.

Benefits of Strabismus Surgery

The main benefit of this surgery is improving how your eyes work together, which can restore 3D depth perception. This is especially helpful for young children so their visual system develops properly.

Risks of Strabismus Surgery

Strabismus surgery is a very safe procedure, but like any surgery, it carries a few minor risks.

• Under-correction or Over-correction: Sometimes your eyes might still turn slightly, or they might turn too far in the opposite direction over time.
• Infection: Germs can enter the eye area and cause an infection.
• Bleeding: Minor bleeding can happen around the surgical site.
• Anesthesia Reactions: Reactions to sleep medicines are rare but possible.
• Double Vision: You might see double for a short period while your brain adjusts.
• Scarring: A small pink mark or scar tissue can appear on the white of your eye.
• Drooping Eyelid: In rare cases, your upper eyelid may droop slightly.
• Scleral Injury: Damage to the white wall of the eyeball is extremely rare.

Recovery Timeline

Expect to take a few days to a week or two off from your normal routine to rest. Your eyes will look quite red and sore for several weeks. You might feel a scratchy sensation like sand in your eye. Complete healing usually takes anywhere from 3 weeks to 12 weeks.

Important Recovery Rules:

• Do not drive until your doctor confirms your vision is stable and safe.
• Avoid swimming pools, hot tubs, and saunas for at least two weeks to keep germs away from your healing eyes.

References & Trusted Sources:
1. American Academy of Ophthalmology (AAO): Strabismus Surgery Overview.
2. NHS UK: Eye Muscle Surgery and Strabismus Treatments.
3. Mayo Clinic: Adult and Pediatric Strabismus Care Guidelines.
4. National Institutes of Health (NIH) / National Eye Institute (NEI): Eye Alignment Research.