Strabismus is a complex visual issue that can often be corrected with surgery. During strabismus surgery, one or more the muscles in the eye is strengthened, weakened, or repositioned to improve eye alignment. The procedure is often performed as an outpatient treatment and does not require overnight hospitalization. In any case, though, knowing what to expect during and after strabismus surgery will help you prepare for the treatment and feel more confident in your treatment decision.
The Strabismus Surgery Procedure
Strabismus surgery is largely consider a routine procedure that is conducted under general anesthesiologist. Any operation that involves even general anesthesia presents some risks.
To begin, the anesthesiologist will meet with you prior to your surgery time. Once he or she has administered the anesthesia and it has taken effect, the surgeon will begin. In most cases, your primary physician serves as the surgeon and has other surgeons assisting in the procedure. Once the surgical team is ready, your surgeon will carefully open your eyelids and identify the muscle affected by the condition.
No incision in the skin is made. Rather, the surgeon will make a small incision in the thin white tissue that overlies the muscle. The identified muscle is then separated from the eye and reconfigured into a new position. The new attachment is made using dissolvable sutures. Your eye is never opened or removed from the socket.
After they begin, most surgeries take anywhere between 30 minutes and 2 hours from start to finish. If it appears that the surgery is taking a long time to family members or other visitors in the waiting room, it is likely because there was actually an unrelated delay in the actual start time of the surgery.
Risks of Surgery
While rare, there are a few risks associated with surgery. Most of these are related to the use of general anesthesia. Although limited, a few cases of reduced brain function, pneumonia, or death have been connected to surgeries involving anesthesia. Additional risks of the procedure itself include vision loss, bleeding, retinal detachment, and infection; however, these complications are extremely unusual.
It is also important to note that the eyes may not appear straight following the surgical procedure. In these cases, prism glasses or another surgery may be needed. Likewise, bleeding beneath the white tissue resulting in a red appearance of the eye for several days to a few weeks, scratching of the cornea, pain, and scar formation also periodically result from the procedure. If you have specific questions regarding risks, be sure to discuss your concerns with your physician.
If the surgeon used an adjustable suture, he or she may perform the adjustment one or two hours after your surgery and prior to your discharge. If you are already awake, the surgeon will administer numbing drops in your eye to numb the surface and adjust the suture to fine-tune the alignment. The adjustment is not usually painful, but some patients do report anxiety, pressure, or discomfort as the sutures are repositioned.
In most cases, the surgeon will leave your eyes in an overcorrected position purposefully. This is because as your eyes heal, they will naturally drift back slightly to the direction they were prior to the procedure. Some individuals experience temporary double vision for a week or so because of this intentional overcorrection.
Most patients are discharged within a few hours of strabismus surgery itself. In most cases, the primary surgeon or a member of his or her staff will call the day after your surgery.
Pain medicine is typically not necessary after discharge. Some patients do find Tylenol or other mild pain relievers helpful for any minimal discomfort. You will, however, be given a prescription for an eye drop or ointment or a combination of both following surgery. This prescription includes both an antibiotic and steroid. These medications are important to prevent infection and reduce scarring in the eye as it heals. Unless your physician directs otherwise, you should be able to restart all of your pre-operation medications, including aspirin, following your surgery.
Once you return home, you should avoid swimming for at least a week. Otherwise, you may resume all normal activity. You should also avoid wearing contact lenses for at least 1 to 2 weeks after your surgery.
If you are experiencing significant discomfort or swelling after your surgery, you can apply ice packs to the operated area for 10 to 20 minutes each hour following your discharge. This ice routine should be enough to reduce swelling and discomfort. Most patients find that a zip-lock bag filled with frozen peas is more effect than eyes as the peas conform more easily to the shape of the eye socket than regular ice. The bag also reduces mess as the peas thaw.
The more aggressive your surgery, the longer your recovery period will be. Typically, you notice minor redness in your eyes for 1 to 2 weeks after surgery. The redness may not totally disappear for several months, however. Some individuals also notice a small, dark “bump” on the white portion of the eyeball after surgery. This bump is the adjustable suture and should dissolve in 6 to 8 weeks.
Your physician will schedule a follow-up evaluation one week after your surgery. However, the final alignment of your surgery may not be fully known for 1 to 2 months after your procedure.
You insurance company will typically receive three bills following your treatment:
- The surgeon’s fee;
- Anesthesiologist’s fee;
- Facility, equipment, and services charges.
Depending on your coverage, most of the procedure should be covered. However, you should check with your provider to determine specific coverage expectations prior to the procedure. You can expect to pay anywhere between $1,600 and $14,000.
Strabismus surgery is a common treatment option. Most patients see a significant improvement in the alignment of their eyes post-surgery. In some cases, however, additional surgery or prism glasses are needed to fine-tune alignment. Each case of the condition is unique and should be discussed thoroughly with your physician to understand the exact goals and results you can expect from your strabismus surgery.