Strabismus Surgery

Misaligned eyes (strabismus) can greatly affect your vision and self-confidence. You may find it difficult to control your eyes or look in one direction.

Fortunately, there are surgical methods that can significantly improve eye alignment. In this article, we’ll go over what strabismus surgery is and how much it can improve your quality of life.

What is Strabismus Surgery?

Strabismus surgery, or eye muscle surgery, is a corrective treatment for eye misalignments. Studies indicate that strabismus affects about 4% of the U.S. population.

Strabismus surgery aims to rebalance your eye muscles to correct misalignments. During the procedure, your surgeon will carefully adjust specific eye muscles to help your eyes work together more effectively.

The procedure may involve:

• Muscle recession. Weakens overly tight muscles by repositioning them slightly further back, reducing their pulling strength.
• Muscle resection or plication. Strengthens weaker muscles by shortening or folding them to increase their pulling power.
• Adjustable sutures. Often used in adults and older teens, these special sutures allow surgeons to fine-tune muscle positioning after you've woken up, improving the precision of alignment.

What Eye Issues Can Strabismus Surgery Treat?

Strabismus surgery treats several types of eye issues. These issues include:

• Esotropia (crossed eyes). When the eye turns inward, towards the nose
• Exotropia (wall eye). When the eye turns outward, away from the nose
• Hypertropia. When one eye turns upward
• Hypotropia. When one eye turns downward
• Cyclotropia (rotational strabismus). When one eye rotates outwards or inwards around its visual axis

What to Expect With Strabismus Surgery

Before surgery, your eye doctor will conduct tests to determine your general and eye health to determine which surgery to perform.

Your doctor may instruct you to stop using certain medications, such as blood thinners and NSAIDs, at least one week before surgery. You should also avoid eating or drinking several hours before surgery.

During the procedure, you’ll be given general or local anesthesia, after which the surgeon will open your eyes with an eyelid holder. They’ll then make an incision in the conjunctiva to access and isolate the eye muscles. 

When the muscle is reattached to the eye wall, the surgeon typically uses a permanent knot or an adjustable suture. They may also use an adjustable suture technique that uses either a temporary bow or a slip knot.

What Happens After the Procedure?

Strabismus surgery is an outpatient procedure, meaning you’ll go home on the same day. Your sclera (white part of your eye) may appear red shortly after.

If your surgeon uses an adjustable suture, they might provide a protective patch to wear. They might also prescribe medications such as antibiotic eye drops or ointments to ease discomfort and prevent infections.

It's also advisable to see your doctor for follow-up care. During follow-up visits, your surgeon will evaluate the healing process and make any adjustments if necessary.

How Long Does Healing Take?

Most people can resume normal activities after about 2 weeks. However, it can take a few months for you to fully recover.

You'll likely experience some pain and discomfort during early recovery, which should clear up with time. Always consult your eye doctor before resuming strenuous or risky activities such as contact sports or swimming.

The surgeon can make adjustments following surgery. They typically perform these adjustments under local anesthesia. 

Ask a friend or family member to drive you to your surgery, as your driving ability may be affected for several days.

Below is a table showing the recovery process for strabismus surgery:

Timeframe	What to Expect Physically	Vision Changes	Activity Guidelines
Day 0 (Surgery Day)	Eyes very red; mild swelling, some blood-tinged tears; mild discomfort	Blurred or double vision is common	Rest, cold compress, begin prescribed eye drops
Days 1 to 3	Redness peaks, slight discharge; discomfort decreases significantly	Improving clarity; intermittent double vision possible	Resume light daily tasks; avoid strenuous activities or rubbing eyes
Week 1	Redness begins fading; sutures may be visible under eyelids; minimal discomfort	Vision stabilizing; alignment near intended result	Return to school or work; avoid swimming and heavy lifting
Weeks 2 to 4	Eyes appear nearly normal; redness almost gone	Visual adaptation complete; minimal to no double vision	Resume all normal activities, including sports after doctor's approval

What to Do During Recovery

During your recovery, follow these guidelines to ensure smooth healing:

• Use prescribed medications. Antibiotic and steroid eye drops prevent infection and reduce swelling.
• Protect your eyes. Avoid rubbing, wear sunglasses outside, and keep water out of your eyes while bathing or showering initially.
• Manage discomfort. Use cool compresses, artificial tears for dryness, and over-the-counter pain medication as advised.

Call your doctor immediately if you experience worsening pain, significant vision loss, severe swelling, or signs of infection such as pus-like discharge.

What Happens if You Don’t Get Strabismus Treated?

If left untreated, strabismus may reduce vision in one eye (amblyopia or lazy eye). It may also result in low self-esteem due to appearance issues.

Early strabismus diagnosis can help identify serious conditions, such as brain tumors. A brain tumor can interfere with the afferent and efferent visual pathways, causing misalignment.

What Are the Risks of Strabismus Surgery

Strabismus surgery often leads to a few common side effects, such as red eyes, double vision, eye strain, headaches, blurry vision, gritty eyes, and swollen eyelids.

However, there is a risk of potential complications, including:

• Poor eye alignment
• Vision changes
• Diplopia (double vision)
• Scarring
• Damaged sclera
• Post-operative infections
• Allergic reaction
• Slipped muscle
• Subconjunctival abscess

You can minimize complications if your doctor thoroughly examines you before the surgery. You should also adhere to post-operative care practices to further reduce risks. 

When Should You Call Your Doctor?

Call your doctor if you notice the following after surgery:

• Obvious signs of bleeding
• Fluctuating vision
• Intense eye pain
• Unbearable light sensitivity
• Signs of infections, such as pus

Who is an Ideal Candidate for Strabismus Surgery

Strabismus surgery is ideal for both children and adults with eye misalignment issues. You may qualify for strabismus surgery if you:

• Have crossed eyes
• Experience blurry or double vision
• Experience changes in depth perception
• Have difficulty reading
• Squint your eyes
• Tilt your head to see clearly

Who Isn’t a Good Candidate For Strabismus Surgery?

You will not qualify for strabismus surgery if you:

• Have muscle or nerve disorders such as muscular dystrophy, myasthenia gravis, or spastic cerebral palsy
• Have unrealistic expectations (e.g., if you expect not to wear your eyeglasses after surgery)
• Have underlying health conditions that can interfere with surgery or healing, such as diabetes
• Take certain medications that can cause excess bleeding during surgery, such as blood thinners

Strabismus Surgery Outlook and Success Rates

In most cases, the procedure is safe and effective. One study shows that horizontal strabismus surgery has a 72.67% success rate.

Additionally, there is a low risk of serious complications. However, it’s important to understand that surgery may not correct vision.

In many cases, success is defined by an improvement in appearance. However, most adults realize some improvement in binocular function after eye muscle surgery. Some people may regain stereopsis (depth perception).

People who don’t have correct alignment after the first strabismus surgery might benefit from a second surgery. This usually happens a few months to a few years after the outcomes from the first surgery have stabilized.

Find an Eye Doctor

If you or your child is experiencing strabismus, scheduling a comprehensive eye exam with a specialized ophthalmologist is your best next step. Early evaluation and appropriate treatment significantly improve outcomes.