Strabismus surgery
Headaches, rubbing of the eyes, apparent discrepancy in the images seen? This could be strabismus. What is the treatment like? How to prepare for strabismus surgery? What exactly is it? Take a look below and check out the types and symptoms of strabismus.
What is strabismus?
A strabismus is an uneven alignment of the eyeballs (resulting from abnormalities of binocular vision or abnormalities of eye movement control). Strabismus is not only a cosmetic defect but often also a functional one, accompanied by various visual disturbances.
Treatment of strabismus
In children, the majority of strabismus is treated by correction with glasses and, in the case of near-sightedness, by covering the good eye. Some cases, however, cannot be cured in this way – despite normal eye vision. Surgery is then required. It is recommended that strabismus surgery be performed no later than when the child is 10 years old. Then, there is a great chance not only for correct eye alignment, but also for correct binaural vision.
In adults, surgical treatment of strabismus is only cosmetic, so here age does not play a role. However, it is impossible to restore normal binocular vision.
Description of the course of surgery
In children, surgery is carried out under general anaesthesia, while in adolescents and adults, surgery is carried out under local anaesthesia by injecting an anaesthetic into the vicinity of the eyeball.
Surgical treatment involves the use of procedures that weaken and/or strengthen the oculomotor muscle using a muscle retraction and/or shortening procedure.
After incision of the conjunctiva and exposure of the ocular muscle, sutures are placed over the muscle and, depending on the preoperative indications, the muscle is retracted, i.e., temporarily detached from the ocular surface and re-sutured in a new designated position and/or, in the case of shortening of the muscle, an appropriately measured part of the muscle is excised and the remaining part is reattached to the original attachment. The fixation threads are trimmed accordingly, and the conjunctival wound is treated with absorbable sutures.
Benefits of the surgery
The aim of the treatment is not only to make the eyes parallel, but thus to create the conditions for achieving normal binocular vision. However, this is only possible if treatment is given early enough, so that the plasticity of the child’s brain can produce the desired eye cooperation. Later in life, the effect may only be cosmetic i.e. parallel alignment of the eyes can be achieved, without affecting their function.
Possible complications:
- reaction to muscle sutures
- conjunctival cyst
- conjunctival infection
- overcorrection or undercorrection of strabismus (treatment is first conservative, but further surgery may be necessary)
- double vision (usually temporary, repeat procedure may be necessary)
Alternative methods
Conservative treatment methods – prism correction for small angle strabismus.
Surgical treatment – the use of procedures to weaken or strengthen the oculomotor muscle (procedure to retract and/or shorten the muscles).
Pre-operative recommendations
- No food for 6 hours and no drinks for 2 hours before the procedure.
- Do not apply make-up, creams or other cosmetics to the face.
- If the anaesthetist has not suggested an individual medication programme, you should take your medications at regular times.
- You should bring your current medication and the results of any pre-operative tests (if recommended by your doctors) with you to the surgery.
- People are advised, particularly those with diabetes, to take a meal with them to eat after the procedure.
- Please bring a loose two-piece outfit (e.g. pyjamas, tracksuit) and footwear for walking around the facility.
- It is a good idea to ask a loved one to assist you during the post-operative period and for transport after the procedure.
- No jewellery should be worn and is best left at home.
Post-operative recommendations
In the first instance, you should read and follow the recommendations individually prescribed by the doctor on the hospital discharge summary report.
After the procedure and anaesthesia, your judgement and reactions may be weaker than usual, although you may not feel this way. It is extremely important that within 24 hours after surgery:
- ensure the presence of an accompanying person, under whose care you will go home with a protective dressing on the operated eye
- not to drive a motor vehicle or bicycle
- not to make important decisions
- on the postoperative day, at the agreed time, come for an examination, during which the ophthalmologist will carefully check the healing process and formulate any further recommendations, as well as set the date of the next follow-up visit.
In addition, it is important to remember:
- There is a wound in the eye that is in the process of healing, which will take about 6 weeks. During this period, there may be a feeling of a ‘foreign body’ under the eyelid, irritation and itching of the eye. These symptoms will gradually subside.
- Occasionally, extravasation of blood under the conjunctiva or in the eyelid area may occur after surgery. The blood is absorbed within a few days. This does not pose a threat to vision.
- The eye dressing should be removed after approximately 6 hours. Wash the eyelashes and eyelids gently with a gauze pad moistened with sterile water.
- You should take care of your hygiene. Do not touch the eye area without first washing your hands.
- Avoid putting pressure on the operated eye and rubbing it; protect it from trauma.
- Any discharge or excess tears should be gently wiped from the cheek with a disposable tissue, which is discarded after use.
- The drops are applied according to the doctor’s instructions at the recommended times, which are indicated on the hospital discharge summary report, according to the eye dropping technique instructions included with the hospital discharge summary report.
- After the first follow-up visit, basic activities can be performed, i.e. bending, walking.
- For 4 weeks after the treatment, avoid heavy physical exertion, strong sunlight, no hot baths, no sauna, no swimming pool, refrain from practising sports. You can read or watch TV.
- Vision should gradually improve after treatment. The result is achieved after a few weeks. Sometimes glasses are required for optimal vision. It is best to choose glasses only after the wound has healed, i.e., after about six weeks. During this time, you can try using pre-fitted reading glasses (your vision will not always be clear in these glasses).
In the event of sudden deterioration of vision or eye pain, please contact the SPEKTRUM Clinical Ophthalmology Centre directly or your attending physician in the first instance (by phone or text message). If necessary, please refer to the eye emergency department.
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