1. Eye muscle surgery involves making an incision on the outer cellophane like covering of the eye, the conjunctiva, and isolating one or more of the eye muscles that move the eyes in various directions.
2. No incision is made on the skin. The eye is not pulled out of the socket. The eye is gently moved no more than one normally moves the eye when looking around. The incision is almost always made on the eye underneath the eyelid so the incision itself is usually not visible unless one rolls the eyelid back.
3. The surgery usually takes 20-40 minutes. General anesthesia is used. There is always a very slight risk (of death or some other serious complication), but the risk is very small, about 1 in 20,000 cases.
4. It is important that the person undergoing surgery does not eat or drink anything after midnight the day prior to the surgery. Nothing by mouth either solids or liquids the morning of the surgery. Sometimes infants under age 1 year can drink milk or liquids until 4-6 hours before the surgery.
5. The success of the surgery is dependent on the ability of the eyes to work together as a team, or the ability of the patient to FUSE or combine the image from each eye successfully into a single image. On average, one eye muscle operation has about an 80% success rate. Another operation may be needed a few weeks, a few months or a few years following the initial surgery.
6. If the patient has an eye muscle problem that is intermittent rather than constant, the chances of success are usually better than if the eyes deviate constantly. If extremely poor vision is present in one or both eyes, the chance of one operation being successful is generally somewhat lower.
7. The surgery is almost always performed as DAY SURGERY: that is, the patient comes into the hospital or day surgery facility the morning of the surgery and goes home the same day. Almost all patients can leave the hospital the same day the surgery is performed.
8. The risk of losing vision from the surgery is extremely small, about 1 in 20,000 or less. If the patient wears glasses, there may be a small change in the prescription following surgery. It is usually best to wait 6 weeks following surgery to change the prescription in the glasses.
9. What about glasses? If you or your child wears glasses prior to eye muscle surgery, glasses will probably (not always) be needed after surgery. If you or your child does not wear glasses prior to surgery, glasses may be needed after surgery to help keep the eyes working together. If prisms are worn in the glasses, then a pair of glasses without prisms should be obtained prior to surgery to be used immediately following surgery.
10. The amount of pain following surgery is variable. Some very young patients wake up with very little pain. Generally, a child will have some soreness in the eyes for 1-3 hours, during which time a cool rag on the eyes is helpful. All patients over age 2 years will receive one medication to prevent pain and one medication to prevent nausea in the IV during surgery. Usually these medications prevent much of the pain and nausea that once followed eye muscle surgery.
11. After 1-3 hours, the eyes are usually not extremely sore. There may be a foreign body sensation, like having an eyelash in the eye that may persist for 2-4 days.
12. The eyes normally stay red for 1-2 weeks or sometimes more following eye muscle surgery. If the redness in the eyes increases markedly, or if the eyelids become red and swollen, an infection on the outer surface of the eye may be present. Antibiotics by mouth may be required. The patient is usually given a prescription for antibiotics by mouth to be used only if the redness and swelling in the eye or the eyelids increases markedly. You should call our office if the redness and swelling of the eye or eyelids increases to find out whether you should begin the antibiotic.
13. If you live within 30-45 minutes of the office, you will usually be asked to come to the office in the first 3-4 days following surgery. If you live more than 45 minutes from the office, you will usually be asked to call us on the Monday following the surgery to see how the eyes are recovering. Following this first postoperative contact, you will usually be seen about 6 weeks following the surgery.
14. Usually a change in the position of the eyes will be noted soon after surgery, but the final effect cannot be completely assessed for four to six weeks after the surgery.
15. If the patient is taking any medications regularly, you should ask whether these medications should be taken the morning of the surgery. Most medications are not given until after the surgery but essential medications (for example, for seizures or high blood pressure) can be taken the morning of surgery with a small sip of water.
16. You will have an opportunity to talk with a member of the anesthesia team, usually one of the anesthesiologists, the morning of the surgery. Patients under age eight or nine years of age are usually “put to sleep” while breathing through a mask. After the patient is “asleep” from the anesthesia, an IV is started to give fluids and medications. In patients over nine years, usually an IV is begun before the patient is asleep and the patient is “put to sleep” with medication given through the IV. If the patient is under age 1 year, sometimes several “sticks” are needed before an IV is successfully started. The IV “sticks” will leave a small mark in the skin that usually heals completely in a few days.
17. Following surgery, eye drops containing an antibiotic to prevent infection and a steroid to decrease redness and swelling will be placed in the eye. This eye drop will be continued following surgery as long as there is any mucus or yellow drainage from the eye. If there is no mucus or yellow drainage from the eye, the eye drop should not be given. The eye drop should not be used simply because the eyes are red; the eye drop should only be continued if a mucus or yellow drainage continue to come out the eye.
18. Eye muscle surgery has become a highly skilled procedure that is often successful in restoring binocular vision. This surgery has only been used widely across the United States over the last 50-60 years and is still only rarely done in many parts of the world. We are very fortunate to live in a country that has been the pioneer of this type of surgery that has been extremely beneficial in improving the eyesight of thousands of people who in years past had no way to regain binocular vision.