Strabismus (Squint) Surgery

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You or your child has been placed on the waiting list for squint (strabismus) surgery. This leaflet is to explain some of the questions you might have. If you still have any further questions, please ask your Surgeon or the Orthoptists for further explanation.

Why the Operation is performed?
The main indications for squint operations are:
1. Functional: If the patient complains of double vision, intermittently or continuously, the operation will aim to get rid of the double vision. It also may help to restore binocular single vision.
2. Cosmetic: In some children and older patients without double vision, the eyes have lost their ability to work together. The need for the operation in this case is for poor cosmetic appearance. There is no urgency to perform this type of surgery and it can be performed at any age.

How the Surgery is done?
The squint operation involves weakening or strengthening certain eye muscle / muscles. The aim is to make the squinting eye point more or less in the same direction as that of the normal eye. The squint operation is usually performed on the squinting eye. In some instances the operation has to be both eyes or occasionally on the normal eye only. Sometimes, in large angle squints more than one operation is required or in certain other types the operation has to be divided into stages. Squint operations are usually performed under general anaesthesia.

Day case or Inpatient Surgery
Most squint surgeries nowadays are performed as day case surgery, i.e. the patient is admitted to the hospital, has the operation, and goes home on the same day.

Pre-Operative Assessment
You will need to attend for a pre-operative assessment a short period before your surgery date. During this visit you will see the Orthoptist who measures your squint. You will also see your surgeon who discusses with you the forthcoming surgery and answers any last minute questions you might have. It is very important to keep this preoperative appointment. Surgery will be cancelled if for some reason the patient is unable to attend for their pre-operative assessment.

The outcome of the Operation
The usual result of the operation is significant improvement in the appearance of the squint. The following should be kept in mind:

1. It usually takes a few weeks before the final outcome of the operation can be determined with certainty.
2. Sometimes it is desirable not to correct the squint fully. In other instances, it is desirable to produce a slight overcorrection.
3. If the patient is wearing glasses, which correct the squint partially before the operation, then these may still have to be worn post-operatively if indicated by the surgeon. The operation is not meant to correct the part of the squint corrected by the glasses.
4. The operation does NOT improve the vision of a “lazy eye”. Patching might have to be continued after the surgery.

Post-Operative Care
Following surgery, you will be prescribed eye drops which need to be used for a period of about 2-4 weeks. These drops will help the eye to heal and prevent infection. Sometimes, the drops produce a local allergic reaction, please contact the Eye clinic. Tel: 01908 826877. Your first visit to the Eye Clinic following surgery will be around 2 weeks after your operation. Sometimes, minute superficial sutures can be seen in the eye. These superficial sutures usually fall off spontaneously. Occasionally, they persist for longer than a few days and can be removed if
causing significant irritation or reaction.

The eye should continue to improve following the surgery. If you have any concerns, or the eye looks very red and sticky, please ring the telephone number given on the front of this leaflet.

You must appreciate that there are no guarantees given and unavoidable surgical complications can occur. There is always some risk in all surgical procedures. The following may be encountered following the squint operation:

• Sometimes, the patient may have double vision following the operation. This usually disappears in 3-4 weeks, sometimes this lasts few months. Occasionally, further surgery is required.
• Under-correction or over-correction of the squint, which might require further surgery.
• The eye is usually red and slightly sore for few days following the operation.
• Occasionally, the redness might persist for a few weeks /months. This usually clears with the use of eye drops.
• Infection might occur which can be treated with antibiotics.
• Localised allergic reaction to the suture might occur, including cyst formation, which can be removed with minor surgery.

Complications Facts & Figures
The British Ophthalmic Surveillance Unit (BOSU) recently conducted a study into severe complications of strabismus surgery in the UK. Complications occur in 3 patients per 1000 (0.3%) overall.

These figures include:

Globe perforation – 1 patient in 1000 (0.1%)
Muscle slippage – 1 patient in 1100 (0.09%)
Loss of vision – 1 patient in 2000 (0.05%)

Other rarer complications were also documented.

Any limitations on activity?
Following the operation it is advisable not to undertake any contact sports or swimming for 4-6 weeks. Vigorous activities should be avoided for about 2-4 weeks. Return to work or school can be done 1-2 weeks after the operation. If double vision persists then return to work might be delayed.