Kids Eye Care of Maryland
Pediatric Ophthalmology and Adult Strabismus
Background and indication for eye muscle surgery:
Eye muscle surgery or "strabismus surgery" is an outpatient procedure. The goal of surgery is to surgically align your child's eyes to better achieve binocular fusion (the eyes working together to give maximal depth perception) and to improve or normalize the field of vision (the total visual area, including "side vision"). Surgery is intended to align or straighten the eyes without much effort on the part of the child. Eye muscle surgery involves either tightening or weakening one or more of the six muscles on the surface of the eye. Nothing is done inside of the eye to change the vision. The eyes are never taken out during surgery.
When strabismus surgery is recommended, we feel that the risk of not doing surgery is higher than the risk of surgery. Each child heals differently. We do the amount of surgery that works on most children. This is done by carefully measuring the amount of misalignment using prisms prior to surgery.
The success rate of this surgery varies from person to person and depends on their particular condition. Usually we can make the eyes 80+% better aligned than before the surgery. The most common risk is that additional surgery will be needed. Some infrequent complications include, but are not limited to, allergy to sutures, risk of infection, bleeding, change in pupil size and a remote chance of loss of vision. We have not ever had any serious ocular complications in our practice.
Prior to Surgery:
A history and physical needs to be completed by your primary care doctor. Please make sure your eye doctor knows of any allergies and a complete medical history even if you think it may not be important. Ask our surgical coordinator, Odalis, if you have any questions (she is fluent in Spanish). Follow the hospital's advice on when to stop feeding solids and clear liquids prior to surgery. You can call the operating room 24 hours per day and ask to speak to one of the anesthesiologists about the particulars regarding feeding or other concerns. If your child is under 2, it is very important to drink close to the maximal time limit, so your child will be nicely hydrated the morning of surgery. Do not give any food/ drink after the recommended limit or your child's surgery may have to be postponed. Our office will usually call you the day or so before surgery in case you have any last minute questions.
We feel that this type of surgery should be performed in a hospital facility. During the surgery the eye is never removed! Rather, the eye is merely rotated through a small incision made under the eyelid, in the clear membrane covering the white part of one or both eyes. Through this incision, the appropriate surgery is then performed on the surface of the eye to improve the strabismus. There are no skin incisions and usually no visible scarring of the eye surface as a result of this surgery.
Normally the surgery takes approximately an hour and a half. This includes the time the patient is brought into the operating room until the time the patient goes to the recovery room. Children require general anesthesia for the surgery.
Young children are put to sleep with a mask. An IV is placed after they are sleeping. Older children go to sleep more easily with an IV. Numbing cream can be placed on the skin so the insertion of the IV doesn't hurt. For children older than 18 months, one parent may go back into the operating room until the child is sleeping. This can be very difficult for the parent and we recommend that the least anxious parent accompany the child as an anxious parent will unwittingly make the child anxious. Often parents choose to have the nurse take their child to the operating room instead of the parent. This usually works well for the child.
What to expect after surgery:
After surgery the eyes are uncomfortable and "scratchy", but not very painful. Each child reacts differently. Some are more sensitive to discomfort than others. Many children do not want to open their eyes for a day or two. This is normal. Children usually only require Tylenol for discomfort. When your child is waking from anesthesia, he or she should be kept from rubbing the eyes. Eye rubbing should not affect the surgery, but can increase the chance of infection. Extra hand washing is recommended for the first week after surgery. Water must be kept out of the eyes for up to 2 weeks after surgery. We recommend a "beauty solon" style bath using a hand-held sprayer (these can be purchased inexpensively from any local hardware/ home improvement store).
There will be some swelling and discharge after the surgery. Immediately after surgery, some children may cry for up to an hour, mainly due to the disorienting effects of anesthesia. Often children will sleep for the remainder of the day. Take it easy with foods, as children may vomit. Vomiting once or twice is normal; however, call your doctor or return to the hospital immediately if your child appears to be very ill or has a fever (this is not normal).
You may want to prop your child's head up slightly at night and expect a small amount of bloody discharge on the pillow the next morning. The swelling should be expected, but mild, and the child should be able to open their eyes within the next day or so, that is, the swelling should decrease as each day goes by. If the swelling increases significantly, contact your doctor immediately, particularly if there is pain. Although it takes around six weeks for the eye muscles to heal, if the position of the eyes are way out of line any time after surgery, contact your doctor.
Children, especially older children, that have eyes that were drifting outward prior to surgery will usually (but not always) have double vision for a limited period of time after surgery (typically over the weekend after surgery). This is normal. This usually resolves within a week, but occasionally lasts longer. Often after surgery to fix eyes that drift out (exotropia), the eyes will appear crossed a bit for the next week or so after surgery. This is normal and expected.
You will be given a tube of ointment to use on your child's eye/ eyes. We will put ointment in the eyes at the end of surgery, so you will not need to put in any until before bedtime or the next morning. Usually we recommend putting in about a 1/2 pea size amount under the lower lid/lids twice a day for a week and then before bedtime for another week or two (or until the tube runs out). When you pull down the lower eyelid (by pressing on the upper cheek bone), you may see purplish blue spots. These are the stitches and will dissolve on their own usually in a few weeks.
One of the doctors will usually call you at home in the evening after surgery is completed to see if you have any additional questions. Usually children and adults after eye muscle surgery can return to school or work early the next week after surgery.
We can be reached at the office at 301-330-1366 at any time which will contact the doctor on call if after hours.
Your doctor will usually want to see you for a follow-up appointment within the next week after eye muscle surgery. Often we do not need you to bring your child for follow-up after naso-lacrimal (tear duct) surgery unless there any concerns.