Strabismus Surgery

When surgery is considered

Surgical correction is discussed when the eye deviation is persistent and does not resolve with glasses or other treatment. Common situations include:

• a noticeable horizontal or vertical deviation that does not go away;
• double vision related to the deviation;
• a habitual head tilt or turn that the patient uses to compensate;
• residual strabismus after childhood treatment or a previous operation;
• strabismus after an injury or illness, once the condition has stabilised.

The doctor makes the final decision after the examination. In some cases surgery is postponed or a different treatment is chosen.

How the surgeon changes the eye position

Each eye is moved by six external muscles. If one of them pulls harder or weaker than it should, the eye turns. The surgeon changes the tension or the attachment point of the muscle. There are three main approaches.

• Recession weakens a muscle. Its attachment is moved back, so it pulls the eye less towards its side.
• Resection or plication strengthens a muscle. It is shortened or folded so that it pulls harder.
• In transposition, part of a muscle is moved to change the direction of its pull. It is used for some paralytic forms of strabismus.

Depending on the case, surgery is done on one eye or both, on one muscle or several. The muscles are usually reached through the conjunctiva, without skin incisions.

Preparing for surgery

Before planning, the surgeon measures the angle of deviation again and checks eye mobility, refraction and binocular function. The accuracy of these measurements determines how the extent of surgery is calculated. If needed, the doctor orders additional tests and general blood work. The type of anaesthesia depends on the patient’s age and the scope of the procedure.

Recovery after surgery

In the first days the eye is usually red, and swelling, watering and a foreign body sensation are possible. The doctor prescribes eye drops and explains which restrictions to follow and for how long. Follow-up visits check the eye position and healing. The final result is not assessed straight away, because the eye position can shift slightly over several weeks.

Possible risks

Like any surgery, strabismus surgery carries risks. The most common is under- or overcorrection, when the deviation is reduced less than planned or changes direction. Temporary double vision sometimes occurs. Inflammation or infection is less common. Some patients need a repeat operation to reach the desired eye position. The doctor explains the risks in your particular case during the consultation.

Cost of surgery

The cost depends on how many muscles need correction and whether one or both eyes are operated on. The price for correcting one muscle is listed in the clinic’s price list, and the exact scope of surgery is set after the consultation.