What is Strabismus Surgery?

Eye movement is controlled by six muscles,
all working together to control where the eyes are looking. Some muscles pull the eyes
up or down, some pull to the left or right, and some work to rotate the eyes when the
head is not straight. When the eye muscles are working correctly, the eyes move together
to focus on the same spot. However, if there is a problem with an eye muscle, both eyes
may not move together and can end up crossing or drifting apart; this is called strabismus.
When both eyes are working correctly and pointing in the same direction, each eye sends a signal
to the brain, and the images from both eyes are combined to make one three-dimensional
view. If the eyes are pointing in different directions due to strabismus, each eye will
detect a different image, and the brain may have trouble fusing those two different images
into one three-dimensional view. When a child has strabismus, the brain sometimes learns
to ignore the image from the misaligned eye. If this is allowed to continue, the child
may never develop good depth perception and may lose sight permanently in the misaligned
eye. Older patients that develop strabismus may experience double vision. Treatment options
depend on the type and severity of the strabismus. For some patients, a non-surgical treatment
is the best option. Sometimes the misaligned eye can be treated with prescription eyeglasses.
In some patients, the eye doctor may recommend patching one of the eyes in order to force
the child to use their weaker eye. Sometimes your physician can monitor both eyes as the
child grows to see if they outgrow their strabismus. For many patients, surgery is necessary to
adjust the eye muscles and straighten the eyes. Your physician will help determine the
best option for you. Before surgery, your child will be put to sleep with general anesthesia,
so they will not feel any pain during the procedure. To begin the surgery, the eye is
gently held open and rotated inside the eye socket. To access the eye muscles, a small
opening is made in a transparent layer of tissue called the conjunctiva. If the muscle
is pulling too tightly on the eye, then the muscle attachment is moved and reattached
to the eye in a different position. To strengthen a weak muscle, a section is removed and then
re-attached to the eye so it will pull tighter. It is common to have more than one muscle
adjusted on one eye, and in many cases, both eyes will need surgery in order for them to
move together. At Children’s Hospital Colorado, most strabismus surgeries are completed in
1 to 2 hours, but plan on spending the whole day at the hospital. After the surgery, it
is normal for the eyes to feel a little itchy, but usually not very painful. If needed, pain
can usually be controlled with over-the-counter medications. We will prescribe eye drops or
ointment to help with the healing process and to make the eyes feel more comfortable.
The eyes are often red or bloodshot for a couple weeks after the procedure, but within
a few days, your child can usually return to normal activities, except for swimming.
Patients must wait at least two weeks before swimming. While strabismus surgery is usually
successful, studies have shown that one in five patients will need another strabismus
surgery later in life. For more information, visit the Children’s Hospital Colorado website.

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