Most Common Questions About Strabismus Surgery

Strabismus treatment is very important for many people, because strabismus itself is a relatively common condition in both children and adults. In this condition, both eyes do not focus on the same object at the same time. One eye deviates inward, outward, upward, or downward while the other eye looks straight ahead.

Strabismus may be temporary in cases of severe refractive error, when the eye has to work harder to focus and the other eye drifts and can’t maintain focus. It may also be permanent if there is a problem with the extraocular muscles responsible for eye movement, or a defect in the cranial nerves or visual centers in the brain.  

There are several treatment options ranging from prescription eyeglasses, eye exercises, or patching the deviated eye. However, when these options fail to correct the deviation adequately, strabismus surgery may be the best option.

Surgery, however, can be a source of anxiety for some patients and their families and often raises many questions. This article focuses on the most frequently asked questions about strabismus surgery and its outcomes.

Will the eye be removed from the eye socket to perform strabismus surgery?

In strabismus surgery, the ophthalmic surgeon makes a small incision in the conjunctiva and the outer layer covering the sclera in order to access the extraocular muscles that control eye alignment and movement. The eye is never removed from the orbit during this procedure.

If my child has strabismus and glasses did not correct the eye position, will the eyes be perfectly aligned after surgery if the doctor recommends it?

In general, if a child is older than 6 months and still has noticeable strabismus, it is unlikely that the eyes will become “perfectly” aligned in every situation. Strabismus surgery can significantly improve alignment in many cases, but it does not guarantee absolute perfection, nor is that a realistic expectation.

Parents should also keep in mind that over the next decade of the child’s life, they may need one, two, or even more additional procedures to maintain the best possible eye alignment as the child grows and the visual system develops.

How does the eye surgeon determine how much surgical correction my child needs for strabismus?

Before surgery, ophthalmologists carefully measure the angle of eye deviation. They then refer to a nomogram, which is a standardized chart based on surgical outcomes from thousands of patients. This helps the surgeon estimate how much to reposition each extraocular muscle and determine the precise site where each individual muscle should be detached and reattached to achieve the desired alignment.

Will my child need to wear an eye patch after strabismus surgery?

Patching is not routinely required immediately after strabismus surgery as part of the surgical correction itself. However, if the child already had amblyopia (lazy eye) before surgery, they will usually still need patching afterward.

In most cases, ophthalmologists try to manage amblyopia (lazy eye) before performing strabismus surgery. If the child does not have amblyopia, it is unlikely that they will need patching of the operated eye after surgery.

In general, remember that strabismus surgery alone does not treat amblyopia. Proper eyeglass correction and amblyopia therapies such as patching or using atropine drops are what improve and rehabilitate visual acuity in the weaker eye.

How does Botox-based strabismus treatment work? Is it dangerous? How long does the effect last?

Botox is the brand name for botulinum toxin, produced by the bacterium Clostridium botulinum. It temporarily relaxes muscles. In certain types of strabismus treatment, the ophthalmic surgeon injects Botox into the medial rectus muscle (the muscle that pulls the eye inward), which may be overacting and opposing the lateral rectus muscle (which pulls the eye outward and is innervated by the sixth cranial nerve).

As the Botox takes effect and the medial rectus weakens, the eye may move toward a more normal position. This can sometimes relieve or reduce double vision and improve alignment enough that glasses can then fine-tune the visual outcome.

The effect of a Botox injection typically lasts from a few weeks to a few months. As for safety, Botox has been used by surgeons in many specialties for many years and is considered very safe and effective when administered by an experienced physician.

Are there any complications associated with strabismus surgery?

All surgeries carry some risk, though the type and likelihood of complications differ between procedures. The main risks associated with strabismus surgery are undercorrection or overcorrection of the deviation, which can occur if the muscles are repositioned too little or too much.

Minor complications may include bleeding, infection, or excessive scarring. In some cases, persistent double vision can occur, which may require additional corrective surgery or special prism glasses to help fuse the images.

Fortunately, serious complications that lead to permanent vision loss are extremely rare in strabismus surgery.