Squint Eye Treatment- Advanced Strabismus Surgery

What happens in Squint Eye Treatment?

Diagnosis 

Typically, strabismus or squint eye is diagnosed during a regular eye examination. Specifically in children, the condition is diagnosed by a pediatric ophthalmologist. In teenagers and adults, an ophthalmologist will diagnose the condition. 

Firstly, the eye specialist will gather your medical history and general health data to identify the cause of strabismus. A normal visual acuity test and refraction test are done to check if the patient also has refractive errors. To determine the type of strabismus and severity of the condition, the following tests are used- 

• An alignment and focus test is done to determine how the eyes are moving and focusing together to analyze whether they are working in unison. 
• The internal structures of the eye are also examined to rule out any underlying disease that may be causing strabismus. 
• Hirschberg Corneal Reflex test is a specific type of test that checks the ocular alignment. It determines the location at which the light falls. It helps to identify the type of strabismus. 

After an accurate diagnosis, the doctor recommends the most suitable method of treatment for squint eyes. 

How to prepare for squint surgery?

The preparation for squint surgery starts with a pre-operative assessment of the patients. Some important tests will be performed to check whether it’s safe or not to carry out the procedure. The doctor and his/her medical team will provide you with specific instructions to prepare you for the surgical procedure. 

The common instructions will include the following- 

• You need to avoid taking certain medications, such as aspirin, ibuprofen, warfarin, and other blood-thinning medications. 
• Avoid eating or drinking anything 4-8 hours before the surgery unless advised otherwise by the surgeon. 
• Take the prescribed medications with a small sip of water. 
• Wear comfortable clothing. It is not mandatory for the surgery, but it will be easier to get the clothes off and wear the hospital gown before the surgery. 
• Avoid using any hair product or makeup product as they contain chemicals. 
• Keep your identification card and health insurance information with you as they will be needed for admission. 
• Whether the surgery is being performed on a child or adult, it is important to have someone accompanying you. You will also need someone to drive you home after the surgery. 

The doctor’s team will contact you before the surgery to ensure that you are well-prepared and provide all the necessary information, including the potential risks associated with the procedure. 

What happens during the surgery?

Before taking you to the operation theater (OT), the patient (or parents in the case of a child) needs to sign a consent form. In the pre-operative area, the patient’s temperature, pulse, blood pressure, respiratory rate, and oxygen are checked. 

An intravenous (IV) line is attached to the arm or hand. The patient is brought into the operating room (OR), and general anesthesia or local anesthesia is administered to the patient to induce sleep or drowsiness. 

The surgery involves the following steps- 

• Firstly, the surgeon places a lid speculum in the eye to keep it open. If the eye muscles of both eyes need to be repaired, the speculum is placed in both eyes. 
• The surgeon will rotate the eye and make an incision in the conjunctiva to locate the muscles that need to be repaired. 
• Once the incision is made, the muscles become clearly visible. 
• Resection, recession, or plication techniques will be used to correct the abnormality in the eye muscle. 
• Resection involves cutting small muscle fibers to make the muscle short or small. Then the muscle is stitched back into its place. 
• A recession involves separating the eye muscle from where it is attached to the eye and reattaching it to a different position on the eye. 
• Plication involves folding the eye muscle and stitching it to form a new shape and size. 
• Typically, adjustable sutures are used to secure the eye muscle in the right place. 
• Before repairing the conjunctiva, the surgeon ensures that the alignment of both eyes is correct. 
• Then the incision made in the conjunctiva is closed using absorbable sutures. 

As soon as the procedure is complete, anesthesia will be stopped. The anesthesia team will ensure that your vitals are stable before taking you to the recovery area. 

What happens after the Surgery?

Immediately after the surgery, you will need close monitoring. Antibiotics will be given to prevent infection in the treated eye. Pain medications will also be given through the IV line. You can expect mild nausea due to the anesthesia. 

The ophthalmologist will check your eye after a few hours. If there are no signs of complications, the doctor will give you permission to go back home. 

You will receive detailed instructions from the medical team regarding eye care after the surgery and for follow-up appointments. You will also be given a list of signs of complications that you need to look out for. 

Benefits of Squint Surgery

The benefits of strabismus surgery are as follows-

• Improvement of Ocular Alignment- With strabismus surgery, the patient can look in the same direction, thus the ocular alignment is properly maintained. 
• Reduction/Elimination of Diplopia- In adults, if diplopia or double vision has occurred, the surgery will address this problem and eliminate strabismus as the cause of double vision. If there is another cause of double vision, the condition will persist even after surgery. 
• Restored Sensory Binocular Vision- Patients with strabismus don’t have a good perception of depth as the field of vision of both eyes doesn’t overlap. After squint surgery, the field of vision overlaps, allowing depth perception, and a single 3-D image of the object is formed. 
• Expansion of Binocular Visual Field- Squint eye often limits the peripheral vision to 120 degrees, due to which the patient can’t look at the sides without turning. The surgery resolves this problem and expands the vision from 120 degrees to 190 degrees. 
• Improvement of Abnormal Head Position- Patients with strabismus often adopt an abnormal head posture (Ocular Torticollis) to optimize their vision and achieve binocular vision. After surgery, the patient won’t have to keep the abnormal position and the habit will improve over time. 
• Improved Social Skills & Self-Image- Many patients with strabismus feel self-conscious due to crossed eyes. The surgery also has cosmetic benefits, as the eyes will appear normal. Thus, the patient won’t feel restrained and their self-image will also improve. 

Alternatives of Squint Eye Surgery

Besides strabismus surgery, there are other options that can be used to treat a squint eye. These options are- 

• Eyeglasses or Contact Lenses- This method is valid for people who have only mild strabismus and have difficulty focusing on objects due to uncorrected refractive errors. 
• Prism Lenses– These are special types of lenses that help to bend the light so that it enters the eye at a correct angle to reduce the turning of the eye to look at objects. 
• Orthoptics or Eye Exercises- The eye exercises work in some cases of squint eye, especially when a patient has convergence insufficiency. 
• Medications– Eye drops or ointments can also be used in some cases to treat crossed eyes. Special injections- Botulinum Toxin Type A can weaken an overactive eye muscle. This method is effective in combination with or as an alternative to strabismus surgery. 
• Patching– This treatment method involves treating amblyopia or lazy eye and strabismus at the same time. But this is a temporary option. 

Out of all the treatment methods available for the treatment of squint eye, eye muscle surgery is the one that provides the best results. 

What happens if strabismus is left untreated?

In children, strabismus is not serious for up to 4 months. After that, if the condition persists, it can lead to several problems. The longer the eyes stay crossed, the brain will start ignoring the images from the abnormal eye. If the treatment is delayed, the brain will again take a long time to control the abnormal eye following the surgery. 

Other problems that can occur if squint eye is not treated as soon as possible are as follows- 

• Lazy eye or amblyopia causes permanent poor vision in the affected eye. 
• Blurry vision that will affect your regular life. 
• Eye strain and fatigue as the unaffected eye have to work more for visual perception. 
• Frequent headaches due to improper functioning of the eye. 
• Double vision or poor 3D vision due to dual image formation in the eyes. 
• Low self-esteem and confidence due to the appearance of the eyes. 

In some rare cases, a brain tumor may also be the cause of strabismus which will go undetected if you don’t see a doctor promptly. 

Recovery & Results After Squint Surgery

The recovery after squint surgery takes around 4 to 6 months. During this period, you will have to take several precautions and follow the doctor’s instructions carefully for successful recovery. 

• In the earlier days after surgery, you will notice pink or reddish tears in the eye. This will take a few weeks to go away. 
• There will be some pain and swelling in the eye, for which medications will be prescribed. Take the medicines as directed by the doctor. 
• You can resume most of the activities within one or two days. Make sure that you don’t engage in any activities that can put a strain on your eye. 
• Also, avoid sports or swimming that can damage the eyes. 
• Visit the eye doctor for follow-up appointments without fail to monitor your eye’s recovery. 
• Eat a healthy and balanced diet that can improve your body’s healing abilities. 

The results of squint surgery will be visible right away and you will be able to look in the same direction using both eyes. In the long term, the eye doctor will strictly recommend that you get annual eye examinations so that vision changes and other problems can be identified and managed properly. If the eye starts to deviate again, a revision eye muscle surgery will also be required for correction.