2440 Ravine Way, Suites 500-600
Glenview, IL 60025

Phone: 847.724.9400

Eye Muscle Surgery

Frequently Asked Questions about Strabismus Surgery:
- includes excerpts from American Association for Pediatric Ophthalmology and Strabismus (AAPOS) website

Background and indications for eye muscle surgery:
Eye muscle surgery or "strabismus surgery" is usually an outpatient procedure. The goal of surgery is to surgically align your child's eyes to better achieve binocular fusion (the eyes working together to give maximal depth perception) and to improve or normalize the field of vision (the total visual area, including "side vision"). Surgery is intended to align or straighten the eyes without much effort on the part of the child, even when he or she is tired. Eye muscle surgery involves either tightening or weakening one or more of the six muscles on the surface of the eye. 

When strabismus surgery is recommended, the earlier in life it is done the better the chance of your child achieving normal binocular vision. Each child heals differently. Along with other factors, carefully measuring the amount of misalignment using prisms prior to surgery helps us to determine the appropriate amount of surgery for your child. 

Risks:
The success rate of this surgery varies from person to person and depends on their particular condition. The most common risk is that the eye muscles will not heal as expected after the surgery and your child may end up slightly over- or under-corrected based on how they heal. Despite having the appropriate surgery, some patients may require further eye muscle surgery (a tune-up or enhancement) in the months or years following their initial operation to further refine their ocular alignment.

Some infrequent complications include, but are not limited to, allergy to sutures or medication, infection, excessive bleeding, excessive scarring, change in pupil size, altered eyelid position, persistent need for glasses &/or bifocals, double vision, and a remote chance of loss of vision or loss of the eye or eyes.

Prior to surgery:
A history and physical needs to be completed by your primary care doctor. Ask our surgical coordinator if you have any questions. Follow the hospital's advice on when to stop feeding solids and clear liquids prior to surgery. You can call the operating room and ask to speak to one of the anesthesiologists about the particulars regarding feeding, if needed.  Remind the hospital of your child's age when calling. If your child is under 2, it is very important to feed/ drink close to the maximal time limit, so your child will be nicely hydrated the morning of surgery. Do not give any food or drink after the recommended limit or your child's surgery may have to be postponed.  The hospital will usually call you the day before surgery in case you have any last minute questions. 

Surgery:
Children require general anesthesia for this surgery and it is usually performed in a hospital facility. Typically the surgery takes 1-2 hours, but varies with each patient. This includes the time the patient is brought into the operating room until the time the patient goes to the recovery room. 

Young children are put to sleep with a mask. An IV is placed after they are sleeping. Older children go to sleep more easily with an IV.  Numbing cream can be placed on the skin so the insertion of the IV doesn't hurt. For younger children, one parent may go back into the operating room until the child is sleeping. This can be very difficult for the parent and we recommend that the least anxious parent accompany the child as an anxious parent will unwittingly make the child more anxious. Often parents choose to have Minou Colis, MD or a pediatric nurse take their child to the operating room instead of the parent. This usually works well for the child.

How does the surgeon approach the eye muscles?
The eye muscles attach to the sclera (wall of the eye). The muscles are covered by a thin layer of transparent tissue called the conjunctiva. The surgeon incises the conjunctiva to access the eye muscle(s), and uses a delicate hook to isolate the muscle. The eyelids are held open by a small instrument called a lid speculum. No skin incisions are made. The eyeball is NOT removed from the eye socket during strabismus surgery.

What is a recession?
A recession weakens function by altering the attachment site on the eyeball. A suture is placed through the muscle at the attachment site to the eye. The muscle is cut from the surface of the eye and reattached further back from the front of the eye.

What is a resection?
A resection strengthens function by reattaching a muscle to the eyeball at the original insertion site after a portion is removed. A suture is placed through the muscle at the intended new attachment site. The segment of muscle between the suture and the eyeball is removed and the shortened muscle is reattached to the eye.

 

      

What is an adjustable suture?


Strabismus surgery involves sewing the eye muscle to the wall of the eye after altering the insertion position and/or the length of the muscle. Standard strabismus surgery (no adjustable suture) utilizes a permanent knot. Adjustable suture technique utilizes a bow-knot or slip-knot (temporary knot) in an accessible position. After surgery the eye alignment can be altered by adjusting the temporary knot. The adjustment is typically done while awake and the operated eye numbed.

What to expect after surgery:

It is normal for the white part of the eyes to be red after surgery. It may take several weeks/months for the redness to disappear. The eyes are usually scratchy and sore upon movement, but not very painful. The soreness usually improves after a few days . Each child reacts differently. Some are more sensitive to discomfort than others. Many children do not want to open their eyes for a day or two. This is normal. Children usually only require Tylenol for discomfort.

When your child is waking from anesthesia, he or she should be kept from rubbing the eyes. Extra hand washing is recommended for the first week after surgery.  No swimming or heavy physical activity for 1-2 weeks after surgery.

An antibiotic/steroid ointment is typically used in the operated eye three times a day for 1 week after surgery.  Patches are usually not used after surgery unless an adjustable suture is used. 

There will be some swelling and discharge after the surgery. Immediately after surgery, some children may cry for up to an hour, mainly due to the disorienting effects of anesthesia. Often children will sleep for the remainder of the day. Take it easy with foods, as children may vomit. Vomiting once or twice is normal; however, call your doctor or return to the hospital immediately if your child appears to be very ill (this rarely happens). 

Ice packs (or a bag of frozen vegetables) wrapped in a towel and applied over operated eye can help reduce the post-op swelling.  You may also want to prop your child's head up slightly at night.   Expect a small amount of bloody discharge on the pillow the next morning. The swelling should decrease as each day goes and your child should be able to open their eyes within the next 1-2 days. If the swelling increases significantly, contact your doctor immediately, particularly if there is pain. Although it takes up to six months for the eye muscles to heal completely, if the position of the eyes are way out of line any time after surgery, contact your doctor. 

Children, especially older children, will usually have double vision for a limited period of time after surgery (typically around 1-2 weeks after surgery). This is caused by post-operative slight misalignment of eyes as the muscles are healing and the brain adjusting to the new position of the eyes. This is normal. This usually resolves spontaneously. 

Dr. Colis will usually call you at home in the evening after surgery is completed to see if you have any additional questions. Usually children and adults after eye muscle surgery can return to school or work the next week after surgery.

Follow-up 
Dr. Colis will usually want to see you for follow-up appointments at 1 day and 2 weeks after eye muscle surgery.