Eyesight MD | FAQ Surgical Treatment of Strabismus

Is Surgery the Solution?

Strabismus is a misalignment of eyes.
There a number of “laymen” terms: Lazy eye, crossed eye, wandering eye…
Strabismus is a general terms that encompasses many forms of Ocular Misalignment.

Types of Strabismus:

Sometimes strabismus presents as a compensating head tilt. Surgical correction often treats the head tilt. This is true for both children and adults.
Sometimes a perceived strabismus is Pseudo-Strabismus
Strabismus can have patterns – such as “A” or “V”
These “patterns” are a sign of early (infantile) interruption of binocular vision development.
The deviation & pattern can be surgically corrected.

Each eye views objects at slightly different angle, from which the brain creates a 3-dimensional image. This requires perfect alignment of the eyes.
In childhood, the brain has the capacity to ignore the image from a misaligned eye, avoiding double vision. But the cost is a “lazy eye” – which if not treated in timely fashion, will result in poor vision for life.
When misalignment develops in adulthood, the brain is not able to suppress the double vision.
The difference between two individuals who have misaligned eyes, one with double vision & the other without double vision, is the age at which the problem began.

The most common causes of strabismus in adults are:
Untreated childhood strabismus
Deterioration of a childhood problem
Recurrence of a treated childhood problem.
All Pediatric Ophthalmologists are initially trained as an Adult Ophthalmologist, and subsequently specialize in the combined field of Pediatric Ophthalmology & Strabismus.
Strabismus is more common in children than adults. As such Pediatric ophthalmologists have the most expertise in dealing with ocular misalignment in all age groups

Numerous studies have confirmed that strabismus is not simply a cosmetic problem.
When ocular deviation is pronounced it becomes a communication disorder – affecting relationships, job performance, and psychological health.
In some, surgery restores binocular function and expands the visual field back to normal.
When there is constant double vision, it is often so disabling that patients have to resort wearing a patch on one eye to function.

Botox® (Botulinum Toxin) was initially developed and tested by Alan Scott MD for the treatment of Strabismus.
It’s use as an agent to smooth wrinkles came a decade later.
The effect wears off in time, and outcomes can at times be unpredictable: as such its use is limited.
In selected individuals it is quite effective, but in general is not a replacement for surgery.

Surgery may not fully address the deviation, and there may be long term shifts, producing over-corrections or under-corrections.
Studies suggest up to 20% of childhood cases may require a future re-operation.

An Adjustable suture is a special type of slip knot, used at the time of surgery, to hold an eye muscle in place.
This technique allows the surgeon to adjust the eye position in the first 24 hours after an operation.
Thus over or under-corrections in the immediate postoperative period can be addressed without requiring a re-operation.

Surgery is generally done as an Outpatient (No hospital stay)
There is no Skin incision.
Access to the eye muscles is achieved by making a small opening (~1cm) and stretching the conjunctiva to expose and operate on the eye muscle(s)

Surgery is generally performed under anesthesia.
Once the eye muscle is exposed, a hook is placed beneath the muscle insertion and a suture is passed close to the insertion of the muscle.
The eye muscle is disinserted and moved to a new position.