How strabismus corrects eye alignment
To understand how strabismus surgery works, consider that each of your eyes has six outside (extraocular) muscles controlling eye movements.
If a muscle is too strong when you have strabismus, it may cause the eye to turn in, turn out or rotate too high or low. These conditions are known as:
Esotropia – Eye turning in
Exotropia – Eye turning out
Hypertropia – Eye drifting upward
On the other hand, an eye muscle weakness in certain cases may also cause misalignment. This condition may occur if you have a cranial nerve dysfunction affecting how eye muscles control movement.
Fortunately, your ophthalmologist has various surgical options to help correct these types of problems. When choosing a strabismus surgeon, look for someone with board certification from the American Board of Ophthalmology and specialized fellowship training in strabismus surgery.
Types of strabismus surgery
Strabismus surgery involving recession and resection procedures
In a recession procedure, your eye surgeon detaches the affected outside muscle (extraocular muscle) from the eye and reattaches it (resection) farther back on the eye. This is to weaken the relative strength of the muscle if it is too strong.
In some cases, the surgeon may use adjustable sutures to allow fine-tuning of eye position after surgery, helping achieve more precise alignment.
Muscles of the eye
In contrast, if the muscle is too weak, your surgeon may use a recession procedure to reduce strength of the opposing muscle (the antagonist). This is to achieve more balanced function of the eye muscles.
In certain cases, a resection procedure may be used to strengthen an eye muscle to correct misalignment associated with strabismus. If you have inwardly turned eyes (esotropia), the surgeon may strengthen the lateral rectus muscles — located on the side of each eye toward the ear — by reattaching the muscle in a different location (resection).
In this way, the lateral rectus muscles are relatively strengthened, and they can turn the eyes further outward. This results in better eye alignment.
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Adjustable suture strabismus surgery
With adjustable suture eye muscle surgery, your surgeon adjusts sutures holding eye muscles in place after a resection procedure. This is in an attempt to improve your final outcome.
Generally, this surgery is possible only in adults, with perhaps only a small percentage able to benefit. This surgery is probably best for someone in whom strabismus developed in adulthood after previously normal eye alignment.
In this case, the person is a good candidate because of fusion potential. This is the ability of both eyes to "lock on" to a target simultaneously, resulting in stereovision and a high degree of depth perception.
In most cases, adjustable suture surgery is performed in the operating room, with general or local anesthesia. Afterward, the eye is patched. About four to 24 hours later, the patch is removed in the office, after anesthesia and sedation have faded. Ocular alignment is then evaluated.
Based on how your eyes are aligned, your surgeon may decide to use the suture that is in place to tighten or loosen the treated muscle. This adjustment may cause slight discomfort, primarily with muscle tightening.
Once the desired alignment is achieved, the surgeon ties the adjustable suture permanently in place, and the procedure is complete.
Strabismus in history
The case of Abraham Lincoln
In some photos and portraits of President Abraham Lincoln, you can see that his left eye tended to look upward. Apparently, he had strabismus.
According to observers, this occurred especially when he was tired or excited, and it was apparent during his famous 1860 presidential election debates with Stephen Douglas.
Because his right eye was the dominant one, he used it much more (such as for reading) than his left eye. The condition may have caused his periodic double vision as well.
What’s more, President Lincoln was kicked in the head by a horse when he was 10 years old. Today, it’s speculated that he may have suffered some nerve damage that caused a droopy left eyelid.
Source: American Academy of Ophthalmology
What to expect after strabismus surgery
Strabismus surgery is generally considered safe and effective. The risks of strabismus surgery and potential complications are overall uncommon or generally treatable. Strabismus surgery success rates are generally good at improving eye alignment, with many patients experiencing better results after the procedure.
Redness and discomfort
Your eyes will be red and somewhat sore after strabismus surgery. You probably will see obvious bright red blood in the surgical area, usually toward the inside or outside corner of the eye. This is normal and is equivalent to bruising of your skin.
Healing timeline
Any broken blood vessels in the eye and general eye redness should fade within two to three weeks. You may feel like something is in your eye, but this sensation will subside. Usually, you can resume normal activities within a few days.
Alignment results
During the first few days after surgery, eye alignment is a good indicator of the final outcome. However, more permanent results may not be known until four to six weeks after surgery.
Long-term management and follow-up
The costs associated with strabismus treatment can vary widely depending on the condition, management type, follow-up procedures and insurance coverage. Children younger than 10 will very likely need a second or third strabismus procedure to maintain the best possible eye alignment.
In some cases, vision therapy, eyeglasses or special prism glasses placed in a pair of glasses may help fine-tune the way both eyes work together (binocular vision).
READ ANSWERS to common patient questions about strabismus surgery
