What is Strabismus Surgery?
Strabismus surgery is a surgical procedure that helps to tighten or loosen the eye muscles in order to change the alignment of the patient’s eyes in relation to each other.
The surgery is also known as eye muscle surgery, extraocular muscle surgery, or eye alignment surgery. The procedure involves a surgery on eye muscles called extraocular muscles and it corrects the misalignment seen on the eyes.8
Strabismus is a condition also referred to as crossed eyes or walleyes where the eyes do not look at the same place together. It can occur intermittently or constantly, for example, when you are stressed out or sick and in some people, all the time.
Treatment of strabismus is focused on correcting the refractive error that could require surgery in some cases. Other times, surgery may be preferred because of the cosmetic benefits.
Some children are born with the condition and it is referred to congenital strabismus but in others, it appears later in life.
Fig: Showing differences observed after strabismus surgery
Types of Strabismus
Esotropia or cross-eye
The eye turns inward usually because of uncorrected farsightedness. Symptoms include experiencing double vision, covering one eye when focusing on near objects and turning the head unconsciously as you focus.
Exotropia, walleye or bottom
The eye turns outward when one cannot coordinate the eyes to work together. These makes the eyes look beyond the object actually being viewed. Such people experience headaches, difficulty when reading and eye strain. They may also close one eye when looking at distant objects or in bright light.
Phoria
An unseen and minor case of the eyes not being aligned. The affected individual may not show symptoms and it is corrected by the brain in most cases. Treatment is only necessary when the phorias are large in which case they decompensate causing double vision.
Tropia
Here the misalignment is visible in either one or both eyes. The eye deviation is in most cases constant or intermittent in which case it is called intermittent tropia.
Causes
In most cases, there is no clear cause for strabismus but the following are risk factors that may predispose one to suffer from the condition.
- Family history
- Refractive error in people who suffer from farsightedness (hyperopia) causing them to turn their heads while focusing on objects
- Medical conditions like Down syndrome and cerebral palsy
Treatment
Treatment of strabismus should begin as early as detected otherwise other conditions may develop. In most cases, adults with strabismus were born with it, therefore, the condition does not get better as the child grows. Treatment may involve:
- Eyeglasses or contact lenses
- Prism lenses
- Vision therapy, for example, children who develop amblyopia (read on) can have the weaker eye trained by patching the stronger eye.
- Eye muscle surgery
Risk Factors
Vision defects
One may develop amblyopia, which is a decrease in vision or sometimes total lack of vision. When coupled with farsightedness, one may develop some head movement behavior meant to make them focus better.
Mental illness
Adults who suffer from non-paralytic forms of strabismus face are recorded to have an increased risk of mental illness. A case-controlled study and survey showed that adults with divergence insufficiency and small-angle hypertropia forms of strabismus may be at a higher risk of suffering mental illness and its comorbidities.
In other studies, children diagnosed with intermittent exotropia and convergence insufficiency forms of strabismus developed mental illness by early childhood.
Surgery
When surgery is opted for or necessary, the length and position of the muscles surrounding the eye are adjusted so as to appear straight. It works best when done during childhood although adults are also not closed out.
Generally, the surgeon opens the outer layer of the eyeball to get to the muscle. Depending on the case, he or she may strengthen or weaken the eye muscle to correct the type of strabismus affecting the patient.
Surgical repair meant to weaken the eye muscle involves loosening the muscle also called the recession. The surgeon may move the muscle back or make a partial cut across it causing the eye to turn away from that side.
When strengthening the muscle, the surgeons tighten, and this is called resection. The surgeon removes a section from one end and attaches it to make the eye muscle shorter causing the eye to turn toward that side.
After the surgery, one may also need vision therapy to keep the eyes from misaligning again. They may also suffer from a double vision that should go away within a few weeks after the surgery as the brain adjusts to improve sight.
Usually, the surgery takes between 30 minutes and two hours.
Recovery Process
Administering anti-infection eye drops
Patients are expected to take anti-infection eye drops after surgery in order to reduce swelling. Both eyes may appear red for a few months after the surgery. The eye drops are a combination of antibiotic and steroid components that work to prevent infection and help the eye heal faster respectively. The patients can then resume normal medication unless otherwise advised.
Use of ice packs
Swelling can also be reduced by placing ice packs on the affected area for 10 to 20 minutes every hour in the evening. Frozen peas in a plastic zipper bag may be preferred because they conform to the shape of the eye while the seal prevents the water of the thawed peas from leaking.
Avoid swimming
After strabismus surgery, a patient should avoid swimming for a period of at least one week.
In some cases, a small dark bump showing the adjustable suture may appear on the white of the eye but dissolves after 6 to 8 weeks. Whether the correction or final alignment of the eye was achieved following the procedure is determined after one to two months.
Complications After Surgery
Unsatisfactory alignment
It is observed that most patients seem to complain about the alignment achieved. Their alignment seems to them as either overcorrected or under corrected. It is usually as a result of the proper alignment or symptoms of double vision. It is important to realize that the final alignment is not achieved until later as discussed above.
Double vision
It is not as common in children as in adults because the child’s brain is able to adapt to the eyes new alignment rapidly. When it occurs in children, it can be an indication that both eyes can receive and appreciate images. It can help for such a child to binocularly fuse or process the images which also results in maintaining straight eyes and good vision.
Infection
It is rarely observed because of the control measures adopted in the surgery. This includes the sterilizing of instruments used for the surgery, taking antibiotics after and attending to any signs of developing infections promptly. Such signs are hard to overlook including extensive swelling, redness of the lids, fever, and pain that does not subside but keeps getting worse.
Loss of vision and excessive bleeding
Occurs very rarely usually as a result of as infection that is not attended to in time. The infection is likely to spread because the eye coat is thin. Addressing the infection early is the only way to prevent such.
Problems arising from anesthesia
This is so rare because of the developments made in anesthesia procedures in the past 20 years. They arise usually from allergies, interactions of medication and other medical conditions. Discussing your medical history including neurological problems, diseases you may suffer from involving the muscles, and cases, where your relatives may have had problems with anesthesia in the past, is a way to avoid such complications.
Cost of Strabismus Surgery
According to a study done by the university of Texas Southwestern Medical Center, the cost of strabismus surgery is about $4, 250 per the individual.
At the Baptist memorial Health Care, TN, it costs around $5,500 and some additional dollars for the doctor’s fee or above $10, 500 if the patient has a scar from a previous surgical procedure.
At Saint Elizabeth Regional Medical Center in Nebraska, it costs approximately $14,000 where the patient has a scar and excluding the doctor’s fee.
It is important to note that the cost of strabismus surgery may vary from one surgeon to another, from one hospital to another, and depending on the complexity of the condition. The figures given above only serve as a guidelines and should not be indicatives of the exact cost you should pay to your doctor or surgeon.
Reference List
- Strabismus surgery. https://www.reference.com/health/recovery-process-adult-strabismus-surgery-7b1b5729375e1def?qo=cdpArticles
- Strabismus. http://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/strabismus?sso=y
- Strabismus. http://health.costhelper.com/strabismus.html
- Strabismus. http://www.webmd.com/eye-health/strabismus
- Strabismus in children. https://www.merckmanuals.com/home/children-s-health-issues/eye-disorders-in-children/strabismus
- Strabismus. http://www.mayoclinic.org/medical-professionals/clinical-updates/ophthalmology/adults-with-nonparalytic-forms-of-strabismus-face-increased-risk-of-mental-illness
- Strabismus Surgery. https://en.wikipedia.org/wiki/Strabismus_surgery