How is strabismus corrected by surgery

Eye muscle surgery (strabismus surgery)

Important NOTE:
The description of the interventions was compiled with the greatest care. However, it can only be an overview and does not claim to be complete. The websites of the service providers and the personal consultation with the doctor or the surgical explanation in the respective operating facility provide further information.
The persons responsible for the content of this website do not guarantee the completeness and correctness of the information, as constant changes, further developments and concretizations are made as a result of scientific research or adaptation of the guidelines by the medical specialist societies.

Here you will find:

Squint (strabismus) is not only a blemish, but can lead to severe permanent visual impairment. This development can often be stopped by an early operation in childhood.
The misalignment of the eyes when squinting leads to the fact that the two resulting images differ so much that the brain can no longer bring them together into a single spatial image. This creates annoying double images. In childhood, the brain defends itself against this by simply switching off the image transmitted by the cross-eyed eye. Without therapy, the unused eye will increasingly have poor eyesight, which can usually no longer be reversed even at school age and will persist for life.

What happens during this procedure?

In the strabismus operation, the squint angle of the diseased eye is surgically corrected until the eye axis is parallel to the healthy eye. Eye muscles that are pulling too hard are placed back on the eyeball, muscles that are too weak are tightened. To do this, the eye does not have to be removed or cut open. Only the slightly healing conjunctiva of the eye is cut open in order to access the muscles.

With paralysis squint, the opponent of the paralyzed muscle is weakened and the paralyzed muscle is removed or folded. The aim here is that the patient no longer sees double images when the head is straight.

In some cases, several interventions may be necessary to correct the misalignment of the eye.

When does the doctor advise you to have this procedure?

A very slight misalignment (latent squint) of the eyes is tolerated by the brain without consequences. In about half of all cross-eyed children, however, the misalignment of the eye must be corrected through an operation. In the case of very young children, you usually wait until the child is wearing glasses reliably, can see roughly equally well with both eyes, and has a sufficient examination by an ophthalmologist. Up to this point in time, the weak eyesight of the cross-eyed eye is prevented with a cover (occlusion) of the healthy eye, whereby the cross-eyed eye is “forced” to see. As a rule, the operation is then carried out in preschool age.
For children who start squinting later (normosensory late squint), the doctor will advise you to have an operation as soon as possible.
If a squint that has existed since childhood is only discovered in adulthood, the poor eyesight of the cross-eyed eye can usually not be changed. The operation then only has cosmetic reasons, the eyesight can usually no longer be improved as a result
A special form is the paralysis strabismus, which occurs more often in adults, which is caused by a sudden paralysis of the eye muscles and is noticeable through double vision and possibly nausea and vomiting. After carefully clarifying the possible causes, surgery is also recommended here.

Which stunning method is usually used?

In children, the procedure is usually performed under general anesthesia. In adults, the operation can also be performed under local anesthesia, usually in the form of conduction anesthesia. This anesthetic also suppresses the protective reflex of the eye and the eye is completely painless and motionless.

If you are one of those people for whom the idea of ​​manipulating the eye is unbearable, general anesthesia can also be considered in adulthood. This also applies to nervous people who find it difficult to keep their head still for long periods of time.

How long does the procedure take on average?

The duration of the procedure depends on the number of muscles that are being operated on.

Who may not be suitable for this procedure?

With very young children, you will usually wait until preschool age. The operation is usually only performed when the eye malposition has persisted for six months.
Otherwise, the procedure can be performed at any age.

How is the risk to be assessed?

The squint operation is a very low-risk operation for the eyesight.

Before the procedure, your doctor will explain very rarely any complications that occur, such as bleeding and infections, to you.

For about 48 hours after the procedure, pain must be expected, especially when moving the eyes, which can be treated with painkillers.

The squint operation is usually only part of an overall treatment concept. In most cases, further regular treatment by the ophthalmologist is necessary and wearing glasses cannot be dispensed with. Sometimes additional surgical corrections are necessary. This must then not be counted as a failure of the operation.

What do you have to consider before the procedure?

If the procedure is performed under general anesthesia, you should not eat or drink any more cloudy liquids 6 hours before the anesthesia! Clear liquids should also not be drunk 2 hours before anesthesia. (Exception: preparation tablet (s) with a little water). Smoking should not be made on the day of anesthesia. If you take medication in the morning, please discuss with your anesthetist which medication you can still take before anesthesia.

What happens after the procedure and what should you watch out for?

Even with outpatient surgery, you will remain under observation for some time after the procedure - until you feel fit for the way home. You are not allowed to drive your own car on the day of the procedure and you should not use public transport on your own. Have family or friends pick you up or take a taxi home.
For the time after the procedure, the doctor will prescribe drops and ointments, which you should use on yourself or your child exactly as directed.

When does the next doctor's appointment usually take place?

On the day of the procedure, your doctor will tell you when you should come back for the next check-up. In your own interest, you should absolutely keep this appointment.
If you get a fever or severe pain at home, you should contact your doctor immediately. Even if you are unsure and still have questions about the normal course of healing, in practice no one will be angry with you if you call for advice.