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When muscles controlling eye movement do not work in unison, one eye may look at one object but the other eye will turn inward, outward, upward or downward to stare at another object. When this happens, the brain receives two different images instead of one image, which confuses the region of the brain responsible for interpreting images. Without professional treatment, children with strabismus (crossed eyes) may suffer refractive errors in one eye as the brain starts ignoring images transmitted by the weaker eye. To help children with strabismus restore their normal vision and eye muscle control, your ophthalmologist in Burlingame CA recommends minimally invasive strabismus surgery for re-establishing binocular vision.
Illustration of the six extraocular eye muscles
Completed as an outpatient procedure, strabismus surgery involves your eye doctor making a small (about 1/4 inch) incision on the membrane covering the sclera (white part) of the affected eye or eyes. At no time is the eye itself surgically entered or removed. Instead, your doctor detaches and reattaches muscles towards the back of the eye or removes tiny portions of muscles to strengthen them and enhance their control over the eye's movements. Depending on how the eye tends to turn (up, sideways, etc) will determine the type of muscle correction your ophthalmologist performs. Strabismus surgery typically takes less than an hour and patients recovery quickly afterward.
As with children, adults who undergo eye muscle surgery can usually achieve precise surgical results with standard surgery. There are occasions, however, when such precision is not possible due to the underlying cause of the strabismus, such as scarring from old surgery, inflammation from eye muscle diseases, or neurological weakness. In these cases, it is sometimes possible to adjust the tension of the muscles postoperatively.
In adjustable suture surgery, the surgery is performed under general anesthesia in the typical fashion except that temporary suture knots are placed. Several hours after awakening from anesthesia, the eye alignment is evaluated. If it is good, permanent knots are tied. If the eyes are not adequately aligned, an adjustment in the tension can be performed. These final steps are completed with the patient awake and the surface of the eye anesthetized with eye drops. When appropriate, this technique can enhance the surgical outcome.
Postoperative problems are minor, involving sleepiness due to the anesthesia and temporary nausea and vomiting. For mild pain or discomfort, Tylenol is suggested, along with rest and eating bland foods if nausea is present.
How well the eyes align when focusing during the first several days following strabismus surgery is a good indicator of how satisfactory the final results will be. However, the actual permanent outcome may not be fully realized for about four weeks to two months.
Recovery from strabismus surgery is usually uneventful and smooth, however, there are postoperative issues that can be anticipated. Some mild sleepiness may persist after awakening from anesthesia. Temporary nausea or vomiting is possible, however, very effective medications are generally given during the surgery to prevent this. Eating and drinking can be resumed as tolerated. If present, pain is usually mild and can be controlled with Tylenol.
Strabismus surgery patients often have mild eyelid crusting or pinkish tears due to minimal blood seepage. Antibiotic eye drops may be prescribed for the first seven days after surgery. Children under 10 often need another strabismus procedure to maintain eye alignment as they mature. Sometimes, your Burlingame CA ophthalmologist may fit children with eyeglasses that enhance their binocular vision.
Photograph of a child in the recovery room following strabismus surgery two hours ago. This child had an esotropia. The ocular surface redness slowly resolves over the course of two weeks.
Generally, no restrictions on activity are required except that swimming should be avoided for two weeks. In the first week or so after surgery, it is not unusual for the eyes to deviate in or out resulting in double vision. The final result of the operation may not be known for six weeks.
If your child has been diagnosed with strabismus and you are interested in learning more about strabismus surgery, please call Kim L Cooper, MD, A Professional Corporation today at 650-259-0300.
The content of this Web site is for informational purposes only. If you suspect that you or your child has an ocular problem, please consult your pediatrician, family practitioner, or ophthalmologist to decide if a referral to a pediatric ophthalmologist is required.