The Surgical Procedure for Strabismus

Anesthesia

Unless otherwise specified, all procedures will be performed under general anesthesia. You will meet the anesthesiologist on the morning of the scheduled surgery.

Surgical Procedure

After the anesthesia is administered, the eyelids are gently opened and the muscle is identified. No skin incision is made. A small incision is made in the thin white tissue (conjunctiva) overlying the muscle. The muscle is then separated from the eye and reattached in a new position using dissolvable sutures. The eye is never opened or removed. Your physician will always be the primary surgeon, but will often have other surgeons assisting in the procedure.

Length of Surgery

Most cases take between 30 minutes and 2 hours after the surgery begins. Family members should not be concerned if it seems like it is taking a long time, as this typically means that there was an unrelated delay in the start time for the surgery.

Risks of Surgery

There are rare risks associated with general anesthesia. Very rarely death, diminished brain function or pneumonia can be associated with general anesthesia. Risks of the surgery include loss of vision, bleeding, retinal detachment or infection but these complications are highly unusual and rare.

The eyes may not be straight following the surgery and prism glasses or another surgery may be required. Minor risks include bleeding under the conjunctiva giving the eye a red appearance for a week to a month. Abrasion (scratch) to the cornea, reaction to the sutures, pain and sometimes scar formation including cyst formation can occasionally occur. Not every possible complication can be listed here and if you have specific questions, please ask your physician, who will be happy to answer them for you.

Alternatives to Surgery

These include prism glasses or Botox injection. Your physician will be able to advise on whether they are appropriate for your treatment.

Suture Adjustment

If an adjustable suture was used, the adjustment will be performed 1-2 hours following surgery while you are in the recovery room, prior to discharge home.

When you are awake, numbing drops are placed in the eye to numb the surface and the suture may or may not be adjusted to fine-tune the alignment. This adjustment is typically NOT painful but patients can sometimes feel anxiety, pressure or minor discomfort while the sutures are repositioned. The eyes are often left in an overcorrected position on purpose because as the eyes heal in the weeks following surgery, they usually drift slightly back in the direction they were prior to surgery. This intentional overcorrection can produce temporary double vision that typically lasts less than 1 week.

Discharge

You will usually be discharged home within a few hours following surgery and your physician or a member of the staff will call you at home the day following surgery.

Care at Home

Pain medication is rarely necessary after discharge but some patients find Tylenol helpful for minor discomfort. You will be discharged with a prescription for an eye drop or ointment or both that is a combination of antibiotic and steroid. These are used to help prevent infection and help the eyes to heal with less scarring. Unless you are told otherwise by your physician, you can restart all of your pre-operative medications, including aspirin, following surgery.

You should avoid swimming pools for 1 week following surgery. You may otherwise resume normal activity as soon as you feel up to it.

If significant post-operative swelling or discomfort occur, these can usually be reduced by applying ice packs to the operated area for 10-20 minutes every hour or so in the evening after you are discharged. Zip-lock bag filled with frozen peas often works better than ice because they conform nicely to the eye socket and is not as messy as it melts.  You should generally avoid wearing contact lenses for 1-2 weeks following surgery.

Recovery

The more extensive the surgery, the longer the recovery period will be. The eyes will remain red for 1-2 weeks following surgery and may not completely disappear for several months. A small dark “bump” on the white portion of the eye can sometimes be seen. This is the adjustable suture and typically dissolves in 6-8 weeks.

Follow-up Appointment

You will be seen for a follow up evaluation one week following surgery. The final alignment may not be known for 1-2 months following surgery.

Bills

There are generally 3 bills that your insurance company will receive following your treatment:
1. Surgeon’s fee
2. Anesthesiologist fee
3. Massachusetts Eye and Ear Infirmary fee that covers all facility, equipment and service charges