Strabismus, or a misalignment of the eyes can be treated with glasses, prism or surgery. Surgery should be considered if glasses, prism or exercises can not remedy the underlying condition. Most procedures take about an hour to perform but more complicated surgeries can take 2 hours+. Strabismus surgery either loosens, tightens or repositions the muscles of the eye to obtain better alignment.
Most strabismus surgery is done under general anesthesia. Children can’t sit still enough for the procedure to be safe under local anesthesia. Furthermore, the surgery can cause nausea, which could be uncomfortable, even for adults.
The eye muscles attach to the sclera of the eye, which is underneath a thin white membrane, called conjunctiva. The surgeon makes an incision through the conjunctiva to access the muscle with a muscle hook. The eye is not removed during the surgery. When the muscle is weakened, the muscle is isolated with a small suture, removed and placed further back in the eye. This is called a recession. Measurements are made prior to surgery to determine how far to move the muscle back. The muscle strength is increased by reattaching the muscle to the original insertion site, once a portion of the muscle has been removed.
In adults and in some children, an adjustable suture may be necessary. In these cases, a slip knot is made and the muscle position is adjusted once the patient is awake.
Before having strabismus surgery, it is important to obtain clearance from the Pediatrician to insure that the patient is healthy enough for general anesthesia. The patient needs to stop eating 8 hours prior to the procedure. After strabismus surgery, the eye is usually a little red for a week or so. Occasionally, the redness persists until the sutures, which absorb in 6-8 weeks, dissolve.
If you or your child’s eyes seem misaligned, please feel free to come for a consultation with myself or the other Pediatric Ophthalmologists.