Suggest Treatment For Vision Problem After Strabismus Surgery

Posted on Sun, 16 Feb 2014

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Sun, 16 Feb 2014 Answered on

Tue, 11 Mar 2014 Last reviewed on

Question : i just had a strabismus surgery It is now day 4, my eye appears to have been overcorrected Is it very likely that I'll need a second surgery?

Answered by Dr. Dadapeer K (38 minutes later)

Brief Answer: Alignment is assessed after 8 weeks of surgery. Detailed Answer: Hello Welcome to Health care magic Iam Dr. Dadapeer, an Ophthalmologist and I answer health problems related to eye. It seems from the history that you had a squint/ strabismus surgery 4 days back and you are noticing as overcorrection of the eyes. The alignment as noticed within first few days is not final as it improves with subsiding of the swelling and edema induced by the surgery. Hence we usually take the alignment after 8 weeks of surgery as the final alignment to decide for over correction or under correction. Infact unsatisfactory alignment is one of the most common problems noted in the immediate post operative period after strabismus surgery. However most of the times it is only apparent and not real and improves by 8 weeks. Hence no need to worry about the second surgery from 4th day of surgery itself, wait till 8 weeks to decide for the alignment and it may become normal by 8 weeks. Please do mention the type of surgery and the type and degree of strabismus you had so that I can advice you more accurately. Hope I have answered your question and the information is helpful to you. Thank you

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dadapeer K (45 hours later)

Hi Dr dadapeer Treatment was right medial rectus recession and lateral rectus resection and upward transposition GA The eye was initially turning inward and downward, my first ophthalmologist commented that for my eyes to appear straight we need to correct it by 15 degrees horizontal and 7 degrees vertical. The 2nd ophthalmologist that I saw and who did the operation said that I needed to have 20 degrees horizontal and 10 degrees vertical. I suspected that he overcorrect the horizontal alignment. How likely is it that my eyes will be back to its center position? At day 7 now, the swelling is mostly gone, and it is very obvious that the eye is now turning outward. People seem to have notice the outward eye movement much

Answered by Dr. Dadapeer K (2 hours later)

Brief Answer: Chances of eyes to become normal are present. Detailed Answer: Hello Welcome to Health care magic Thank you for the follow up query. I reviewed the history, you have undergone horizontal muscle surgery with upward transposition for correction of the torsional component of the squint. The basis of squint surgery is to weaken (RECESSION) the overacting muscle and to strengthen (RESECTION) the underacting muscle. Each millimeter recession or resection of will correct approximately about 5 prism dioptres of squint. The measurements actually depend on the amount of squint as measured from various tests. Most of the surgeons follow the same formula to calculate the amount of muscle to be recessed or resected. Since the difference in the assessment between two doctors is only 5 degrees for horizontal and 3 degrees for vertical, there is not much difference in it. Since it is only 7 days of surgery In think you need to wait for another 6- 7 weeks after which you can get the final assessment done. Hence I advice you to wait till 6-7 weeks and do attend followup with your doctor as advised, I guess chances that alignment of the eyes will become normal are fair and you can wait till some time before deciding on over correction or under correction. The alignment problems are commonly seen in the post operative period with more than 70% of them becoming normal by 2 months. Hope the information is helpful to you Thank you

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dadapeer K (11 hours later)

Thank you Dr In the case that it is an overcorrection after 2months checkup, when is the earliest that I can do another surgery? What are the complications of doing the surgery on the same muscle twice? How likely the alignment of the eye can be corrected in the 2nd surgery? How high is the possibility for another over or under correction? In most strabismus surgery in adults, how long do the eyes normally hold up? If the eyes do begin to turn in a few years time, do they normally turn back to their original position (in my case inward) or they are like to move outward? Thank you

Answered by Dr. Dadapeer K (6 hours later)

Brief Answer: Repeat surgeries are common following squint. Detailed Answer: Hello Thank you for the follow up query. Coming to your questions, 1. Over correction after 2 months of surgery can be operated any time after the final assessment as the surgery related inflammation and edema subsides. 2. The complications of surgery for the second time are basically related to scarring caused by the primary surgery, thus making the surgery a bit difficult compared to primary surgery. 3. As I had mentioned in my previous answer misalignment is common problem after squint surgery. The success rate in children is only 45% whereas it is more than 70% in adults. To avoid under correction or over correction we advice squint surgery with adjustable sutures so that misalignment can be adjusted in the early postoperative period. 4. Usually following adult squint surgery the rate of recurrence of squint is less, it is common in children as the eyes may not fuse because of absence of binocular vision and the eyes may drift away causing recurrence of squint. Normally if the alignment drifts away it will go back to its previous position which was present before surgery, in your case inward. Hope I have answered your four questions and the information is helpful to you. Thank you

Above answer was peer-reviewed by : Dr. Prasad