What to expect before, during and after strabismus surgery?

What to expect before, during and after strabismus surgery

Strabismus, commonly referred to as crossed eyes, occurs when the eyes do not align properly. This condition can affect vision, depth perception, and confidence. Strabismus surgery (eye muscle surgery) can be an effective solution to correct many types of eye misalignment. If you are considering this procedure, understanding what to expect at every stage—before, during, and after—can make the journey smoother. Here is an in-depth look.

Before strabismus surgery

Strabismus surgery

Proper preparation is essential for a successful outcome.

1. Comprehensive evaluation

Before surgery, you will undergo a thorough assessment, including:

  • Detailed eye examination: To measure the degree of misalignment and evaluate eye muscle function.

  • Medical and Family history: The doctor will discuss any previous surgeries, medical conditions, or medications you are taking.

  • Diagnostic tests: Special tests such as prism tests, ocular motility studies, and measurements of deviation angles may be performed.

2. Pre-surgical planning

The surgeon will plan the procedure based on the type and severity of strabismus. Factors like the involvement of one or both eyes, muscle strength, and patient age play a crucial role.

3. Preoperative instructions

You will receive detailed guidance to prepare for surgery:

  • Fasting guidelines: You will need to stop eating and drinking several hours before the procedure.

  • Medication adjustments: Some medications, such as blood thinners or aspirin, may need to be paused.

  • Lifestyle recommendations: Smoking and alcohol consumption should be avoided as they can hinder healing.

4. Psychological preparation

It is normal to feel anxious about the surgery. Discussing concerns with your doctor and understanding the procedure can help reduce anxiety.

5. Logistical preparations

  • Arrange for someone to drive you to and from the surgical centre.

  • Plan for a few days of rest at home post-surgery.

During strabismus surgery

Strabismus surgery is typically performed on an outpatient basis, meaning you can return home the same day.

1. Anaesthesia

  • Children and adults: General anaesthesia ensures that the patient is asleep and comfortable throughout the procedure.

  • Adults: Local anaesthesia with sedation may be suitable and recommended for some patients.

2. The surgical procedure

The surgeon makes a small incision in the conjunctiva (the clear membrane covering the white part of the eye) to access the eye muscles. Depending on the type of misalignment:

  • Muscle weakening: Muscles causing excessive pull are repositioned or relaxed to reduce their strength.

  • Muscle strengthening: Weaker muscles are tightened or shortened to enhance their function.

  • Adjustable sutures (in adults): Some cases may involve adjustable sutures, allowing post-surgery refinement of the alignment.

The surgery generally lasts about 1 hour, depending on the complexity.

3. Monitoring

After the procedure, you will be moved to a recovery area for observation until the effects of anaesthesia wear off.

After strabismus surgery

after strabismus surgery

Recovery and follow-up care are critical to achieving optimal results.

1. Immediate recovery

  • Expect mild to moderate discomfort, redness, and swelling around the eyes.
  • Vision may be blurry, and you might experience double vision as your brain adjusts.
  • Nausea and drowsiness from anaesthesia are common, but usually resolve quickly.

2. Post-surgical instructions

Your surgeon will provide specific aftercare guidelines, including:

  • Medications: Use prescribed antibiotic and anti-inflammatory eye drops as directed.
  • Ice compresses: Applying ice can help reduce post-operative swelling.
  • Hygiene: Avoid touching or rubbing the eyes.
  • Activity restrictions: Rest for a few days, and avoid heavy lifting, swimming, or strenuous activities for at least two weeks.

3. Follow-up visits

Regular follow-ups are essential to monitor healing and eye alignment. Your doctor may perform additional tests to evaluate the success of the surgery and discuss further treatment, such as eye exercises.

4. Potential side effects

It is normal to experience:

  • Redness and swelling of the eyes, which can last for many weeks.
  • Temporary double vision, as your eyes and brain adjust to the new alignment.
  • A mild foreign body sensation, similar to having sand in your eye.

These side effects usually resolve on their own.

5. Long-term recovery

  • Most patients resume normal activities within one week.
  • Complete recovery can take up to 6–8 weeks, or longer.
  • In rare cases, a second surgery may be required to achieve perfect alignment.

When to seek medical attention?

While complications are uncommon, contact your doctor immediately if you experience:

  • Severe pain unrelieved by medication.
  • Excessive swelling or discharge from the eye.
  • Persistent double vision lasting beyond the expected recovery period.
  • Signs of infection, such as fever or redness spreading beyond the eye area.

The emotional and visual impact

For many, strabismus surgery is life-changing. It not only improves eye alignment and vision but also boosts confidence and social interactions. Children often gain better academic performance and self-esteem, while adults experience greater ease in professional and personal settings.

Conclusion

Strabismus surgery is a safe and effective way to correct eye misalignment. By preparing adequately, following post-operative care instructions, and attending follow-ups, you can maximise the benefits and success of the procedure.

At Clarity Eye Surgeons, our team of experienced specialists is committed to providing personalised care throughout your journey. If you are ready to take the next step or have questions, schedule a consultation with us today. Together, we will help you achieve clearer vision and renewed confidence!

Author bio

Dr Parth Shah is a director and principal ophthalmologist at Clarity Eye Surgeons in Canberra, specialising in strabismus surgery. With extensive training and experience, he is renowned for his expertise in the field. Dr Shah is dedicated not only to performing successful surgeries but also to patient education. His compassionate approach, combined with technical proficiency, has earned him the trust and gratitude of countless patients. He is a true advocate for eye health and a trusted name in the Canberra ophthalmology community.

FAQS

Yes, strabismus surgery can be performed on adults. While many cases are treated during childhood, adults can benefit from the procedure for both reconstructive and functional reasons.

In some cases, surgery can enhance depth perception, especially if the eyes were significantly misaligned. However, the extent of improvement depends on the severity and duration of the misalignment.

Yes, in some cases, non-surgical options such as eye exercises, prism glasses, or botulinum injections may be recommended. However, these alternatives are not always effective for severe or large misalignments.

Adjustable suture surgery allows the surgeon to refine the alignment of the eyes after the surgery, while the patient is awake. This method is primarily used for adults and can enhance precision. The muscle is left on an adjustable slipknot, and the position can be adjusted depending on the eye alignment. 

In many cases, glasses or contact lenses will still be necessary after surgery to correct refractive errors or residual misalignment. Your surgeon will advise based on your specific condition. Glasses may need to be updated following surgery, due to a change in the eye shape and focus.

Strabismus can recur in some patients over time, especially in cases with underlying neurological or muscular conditions. Regular follow-ups and additional treatments can help manage recurrence.

Overcorrection or undercorrection can occur following eye muscle surgery. If this happens, a second surgery may be needed to fine-tune the alignment.

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