Strabismus Surgery (Eye Realignment)

ESOTROPIA, EXOTROPIA, HYPOTROPIA, HYPERTROPIA, 3RD/4TH/6TH NERVE PALSIES, DUANES SYNDROME, ABNORMAL FACE TURN, NYSTAGMUS

Six eye muscles move each eye.  Strabismus means the eyes are misaligned.  The eye muscles can be tightened or loosened to improve the alignment of the eyes.  Strabismus surgery can be performed if glasses do not correct the misalignment.  Eye muscle surgeries are restorative, and may do much to improve visual function, social interaction and self esteem.  Eye muscle surgery should not be considered “cosmetic”.  It is not normal to have misaligned eyes.  You go home on the same day after eye muscle surgery.

 

                                                                                                     

1.  Provide Dr. Ing with a clearly focused, head-on face photo of yourself to help with the surgery. Be realistic. Surgery can usually improve crossed eyes, but will not make perfect what was imperfect to begin with.  In patients with double vision, the main goal of surgery is to decrease the amount of double vision or eye strain when the patient is looking straight ahead or reading. In children, strabismus surgery may decrease the chance ongoing amblyopia, but glasses and patching may still be required.  The secondary aim of strabismus surgery is improve the patient’s appearance.

2. It is not uncommon for the eyes to be red or inflamed after surgery.  The  POTENTIAL RISKS of strabismus surgery include uncontrolled bleeding, infection, vision loss/blindness (risk < 1 in 20,000), asymmetry, persistent eye irritation, and double vision.  It is not uncommon for the eyes to become crooked again with time, following strabismus surgery, especially in poorly seeing eyes. Rarely patients may develop a severe allergic reaction to the anesthetic. Strokes and death are extremely rare complications of ophthalmic surgery. (risk < 1 in 20,000)

3.  STOP ASPIRIN, ADVIL, VITAMIN E, GINGKO BILOBA and other blood thinners IF possible.  If you take aspirin, consider stopping it for 10 days prior to your surgery, IF agreeable with your family doctor/internist.  (If you take pradax, xarelto, coumadin or plavix, consult with your family doctor or internist before stopping it.) Tylenol (acetaminophen) can be used for pain relief without increasing your bleeding tendency. You can usually restart your aspirin or advil 1-2 days after surgery.

4. DO NOT EAT OR DRINK STARTING AT MIDNIGHT BEFORE YOUR SURGERY. You can take prescription medications with a sip of water. Diabetics should NOT take their diabetes pills the morning of surgery, and use at most half their normal insulin dose.  IF GOING TO THE MAIN OPERATING ROOM, ARRIVE 2 HOURS BEFORE THE SCHEDULED SURGERY TIME. Arrange to HAVE FAMILY/A FRIEND pick you up after the SURGERY.  A few patients have marked nausea after surgery, despite being given prophylactic medication after surgery.  Just in case bring towels or plastic bag for the car ride home. 

5. YOUR EYE/EYELID MAY APPEAR RED, BRUISED AND PUFFY FOR MANY WEEKS.  The bruising is usually most prominent a few days after surgery.  The conjunctiva is transparent, and the space underneath the conjunctiva very thin.  A small amount of bleeding will appear as a prominent hemorrhage. The eyelid may also be bruised as the eyelid is the thinnest skin in the body. Your eye and eyelid may be swollen and bruised for several weeks after surgery. If you have had prior muscle surgery, it may take even longer for the eye redness to resolve. If you have to pose for an important picture wait for at least 6 weeks after the surgery, so that you will look more natural. Some patients develop a proliferative healing response (“pyogenic granuloma”)

6. CARING FOR YOUR EYE AFTER THE SURGERY A patch is usually not required.  To decrease swelling you can place a cool cloth or kleenex on the eye(s) that were operated on through the closed eyelid. Cold compresses can be made by dipping a clean cloth or tissue in ice water, or by placing some frozen peas in a plastic bag. Usually Dr. Ing asks you to put some antibiotic drops (e.g. Tobradex) in the operated eye(s) 2-4 times a day, for 7-10 days. It is common to have your eye(s) feel itchy, scratchy, gritty, dry or even watery after surgery.  If this happens use over-the-counter lubricating drops or ointment (e.g. Refresh liquigel or Celluvisc) in your eye 4-6 times per day, and you will feel better. Try using the drops even if your eyes seem too watery at first. You can do light work the day after surgery, and children can usually attend school within a few days.   


WASH YOUR HANDS. Avoid dusty, dirty environments for the first week.  You can take showers with your eyes closed right after surgery, but no swimming.  Do not let the family pet lick your face.  Do not touch your mouth and then touch your eye. 

Glasses may be required after strabismus surgery, especially if the patient wore them before the surgery. Wearing the proper glasses prescription will decrease the chance of long term drift of poorly seeing eyes. Depending on your particular operation, Dr. Ing or his assistant may check you again on the day after the surgery, or ask you to return to the office in 1-6 weeks.

7. The most important objective of strabismus surgery is to improve the alignment when the patient is looking straight ahead.  Even after surgery, patients with complex strabismus may not see single when looking in eccentric positions of gaze.  Some patients may see double when looking  straight ahead for the first few  weeks following surgery, but this usually improves as the eyes learn to work together again. Surgery may not eliminate double vision when you look off to the side, up or down.  If the double vision persists after 3-6 months, Dr. Ing can determine if prism glasses or further surgery is the better option.

8.  MORE THAN ONE OPERATION MAY BE REQUIRED.To minimize scarring and overcorrections, it is better to err on the side of doing less surgery than too much surgery.  Depending on how you heal, an augmentation procedure may be indicated to give you the optimal result. It is not uncommon for a pre-existing vertical deviation to be unmasked after a horizontal deviation is corrected. Patients with dissociated vertical deviations sometimes require contralateral surgery if only one eye is operated on.  Repeat operations are more common for large deviations, patients with poor vision and cerebral palsy patients.  It is not uncommon for strabismus to recur over time.

EMERGENCIES: If you cannot reach Dr. Ing through his office, go to your nearest emergency room.  If Dr. Ing is not on call, one of the other 9 ophthalmologists will be covering urgent eye problems that come through the Michael Garron Toronto East General emergency room.