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Strabismus is a condition in which your two eyes are not aligned and point in different directions. One eye may be focused straight ahead, while the other eye is looking up, down, left or right. The maladjusted eye may maintain one position, or it can drift. It’s also possible for the affected eyes to switch positions; the stable eye might suddenly become the roving one and vice versa.
Also known as cockeyed or cross-eyed, strabismus occurs in five percent of children. It’s generally caused by trouble with the eye muscles, the nerves connected to these muscles or the brain itself. The condition can also be caused by disease or traumatic eye injury.
Strabismus Surgical Options
Strabismus surgery is an operation to correct this misalignment of your eyes. The surgery focuses on two basic goals:
- It seeks to adjust the alignment of your eyes so your brain can coordinate the two, producing an overlapping field of view with proper depth perception (called binocular vision).
- Concurrently, the surgery improves the appearance of your face by straightening and coordinating ocular alignment.
The success rate for strabismus surgery ranges from 50 to 90 percent, and its success depends on a variety of factors, such as:
- Severity of the misalignment
- Your age
- Ocular depth perception
- Condition of your eye muscle tissue
- Your fidelity to pre- and post-op therapy
Due to the variety of factors influencing the probability of a favorable outcome, it’s entirely possible that more than one operation may be required to correct your alignment. In difficult situations, where your eye muscles have serious abnormalities, the procedure can be divided into phases. Each operation is conducted to fix one issue, and subsequent surgeries correct others. It even happens that fixing one section of your eye reveals a previously unknown defect.
Other Factors to Consider
Six eye muscles are involved in the aiming of each eye. There are four rectus muscles connected to the eye, with the superior pulling the eye up, the inferior pulling it down, a medial rectus muscle on the nose side pulling in, and finally, the lateral rectus on the ear side pulling outward.
The other two are more complex and are called obliques. The upper back section of the eye is connected to the superior oblique, and it pulls the downward when viewing the nose. The inferior oblique attaches the lower back part and performs the opposite function in the same situation.
Strabismus can be a result of one of these muscles being too strong, so when your brain directs your eye to aim in a certain direction, the muscle pulls too forcefully, causing an over-rotation. A weak eye muscle also prevents correct alignment by under-rotation. Concurrently, there may be a defect in one of the cranial nerves affecting the aim and/or movement of one or both eyes. Surgical procedures exist to correct each of these issues.
The coordination of both eyes occurs in the middle of the brain. It works just like the front axle of a car steers both front wheels on a car. Therefore, though only one eye may appear out of alignment, it’s really an issue of the two eyes being out of sync. Strabismus surgery attempts to fix the eye muscle of either or both eyes.
Strabismus Surgical Procedures
There are two basic procedures involved in strabismus surgery:
- When the strabismus results from an overly strong eye muscle, the goal is to weaken the muscle through a procedure called recession.
- Conversely, if a muscle needs to be strengthened, the operation is called a resection.
Surgery is accomplished by exposing the eye muscle through an incision in the thin white skin covering the surface of your eyeball called the conjunctiva. This is the same tissue that appears “blood shot” after an irritation to your eye. Since your eye muscles are concealed beneath this tissue, there is no need to cut through your eyelids or face to gain access.
Strabismus surgery doesn’t require the removal of your eye from its socket. The eye muscles themselves are only one-quarter of an inch away from where your cornea meets the white conjunctiva, so access to these muscles is relatively easy.
In the recession procedure, the tendon attaching the muscle to the eye is detached and reattached a fraction of an inch away from the front of the eye. Retraction is performed in the opposite manner, by moving the muscle closer to the front. The exact distance to move the muscles is determined prior to surgery, and the operating procedure should take no longer than 30 minutes. Of course, this does not include the preparation time or the time you’ll spend recovering from the anesthesia.
In both scenarios, the stitches used to re-attach the muscles and close the conjunctiva dissolve and are absorbed by the tissue, so there is no need to remove them at a later date.
Risks of Strabismus Surgery
Commonly, complications involving infection and mild scarring do occur, but they seldom cause any long-term problems. Less common problems that do result in clinical dilemmas include:
- Stretched scars
- Slipped muscles
- Incarcerated muscles
- Lost muscles
- Orbital cellulitis
- Retinal detachments
- Surgical errors
- Endophthalmitis, a bacterial or fungal eye infection
Recovery from Strabismus Surgery
Expect red, sore eyes following strabismus surgery. It’s common to see conspicuous amounts of blood appearing under the surface of the conjunctiva in the area of the sutures in either corner of the eye. It’s completely normal and should be considered no more serious than bruised skin.
The redness in your eyes caused by the burst blood vessels normally disappear in less than three weeks. Initially, it might feel as if something’s in your eye, but this feeling diminishes over time. You should be able to return to your normal routine in just a few days.
By the time you’re back to your usual activity, the results of the eye alignment should start to be apparent. Nevertheless, expect to wait four to six weeks for the final outcome. Second and third strabismus surgeries are often necessary for children under the age of 10 to ensure the proper ocular alignment.
Important Reminder: This information is only intended to provide guidance, not a definitive medical advice. Please consult eye doctor about your specific condition. Only a trained, experienced board certified eye doctor can determine an accurate diagnosis and proper treatment.
Do you have any questions about strabismus surgery in NYC? Would like to schedule an appointment with the top NYC Ophthalmologist specialist, Optometrist Dr. Saba Khodadadian of Manhattan Eye Specialists, please contact our office for consultation with New York eye doctor.
Dr. Saba Khodadadian, Optometrist (NYC Eye Doctor)
New York, NY 10028
(Between Madison Ave & Park Ave)
☎ (212) 533-4821