Adult Strabismus Surgery

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This leaflet is intended to answer some of the questions of patients or carers of patients listed for strabismus surgery under University Hospitals Sussex NHS Foundation Trust.

What is a strabismus?

Strabismus is the term used to describe eyes that are not pointing in the same direction and not working together. A strabismus may be present occasionally or all of the time. It may be only in one eye or may alternate between the two eyes.

Why operate?

The main reason for surgery can be to improve the cosmetic appearance of the eyes or to allow the eyes to work together more easily. Surgery may also be done to reduce double vision or to improve a head posture. The aims of surgery should be discussed with the orthoptist prior to the operation as they will vary depending on the type of strabismus.

Before the operation

You will be placed on a waiting list and how long you may have to wait will be discussed at the time of listing for surgery. You will receive an appointment to come in for orthoptic measurements up to six weeks prior to the surgery. You will also need to have a general anaesthetic assessment.

On the day of surgery, you will be seen by a nurse to discuss everything that is going to happen. An Orthoptist will come to do repeat measurements and an anaesthetist will explain the anaesthetic procedure and the surgeon will explain the risks and benefits of the surgery and complete the consent form.
Risks include:
• Having a general anaesthetic can be a risk. The anaesthetist will discuss this with you.
• The surgery may not produce the desired result (under or over-correction).
• There is a risk of eye infection after the operation. You will be given eye drops to prevent this.
• Double vision may be noticed for a short time after the operation. The likelihood of this will be discussed with the orthoptist prior to your operation.
• There is a very small risk of visual loss. This is rare.
The procedure usually takes 40 to 90 minutes depending on the surgery involved. You will not need to stay in hospital overnight.

How is the strabismus corrected?

The surgeon will move the eye muscles on the outer surface of the eye to strengthen or weaken their action. There are six muscles on each eye and the surgeon and the orthoptist will decide which muscles need to be adjusted. This may be on one or both eyes.

The eye is NOT taken out.

After the surgery

Once the operation is over, you will be taken to recovery. Once awake, you will need to eat / drink something. You will be given tea / coffee and a biscuit.
Immediately after the operation the eye(s) will be red and swollen. You may be able to see a small black stitch on the white of the eye. The eye(s) will feel sore for a few days after the operation and may feel “scratchy”, but any pain can usually be controlled with paracetamol or ibuprofen.
Before you leave the ward, you will be given a follow-up appointment and eye drops will be prescribed to reduce inflammation and prevent infection.
Make sure you always wash your hands before touching the eye or putting the drops in. To use the eye drops effectively, tilt your head back and pull the lower eyelid down. Drop an eye drop onto the inside of the lower eyelid, release the lid and wipe away any excess fluid. Do not touch the eye with the bottle. If you are not sure the drop has gone in, it is safe to use another.
To clean the eye use cooled boiled water and a small piece of gauze, wiping outwards from the nose to the temple. Repeat as necessary.

Advice after surgery

• Avoid swimming, strenuous activities or contact sports for one month.
• Avoid dusty environments for two weeks.
• Take care when washing hair; avoid getting anything into the eyes.
• Sunglasses may protect the eyes from wind and sun.
• You may need to be off work for up to two weeks.
• Do not patch the eye.
• Follow your orthoptist’s instructions on glasses, close work, use of TV / computers and exercises.