Strabismus surgery

When both eyes do not look in the same direction, we speak of strabismus or strabismus. The causes are manifold and range from isolated misalignment of the eyes to paralysis, injuries and - fortunately rarely - tumour diseases. Untreated visual impairment can also result in strabismus.

Strabismus is a misalignment of the eyes in which an object cannot be fixed with both eyes at the same time. One eye deviates from the visual axis. Either always, or only sometimes. Either only one eye at a time, or alternately. Either with double image perception, or with switch-off phenomena on the part of the brain. This can result in various problems, for example - in children - amblyopia (visual development deficit), in which the vision - usually of one eye - does not develop properly. Parents do not always notice that one eye deviates from the line of vision of the other, e.g. in the case of micro-strabismus, which is sometimes not even noticed by the paediatrician and nevertheless often leads to high amblyopia. In early childhood strabismus, there is often a family history of the condition. There are also some early risk factors such as prematurity or oxygen deficiency.

Misalignment of the head, conspicuous squinting of the eyes or sudden unsteadiness can indicate a strabismus that may not otherwise be noticeable.  

In other strabismus disorders, people suffer from headaches, tired eyes, blurred vision or double vision.  

If an adult suddenly becomes cross-eyed without any obvious cause, there are many possible reasons. An ophthalmological examination is definitely necessary.

How can strabismus be treated?

There are various forms of therapy available for the treatment of strabismus. Small squint angles can (indeed, must) often be corrected with the right glasses if the defective vision is the cause of the strabismus. 

With children, a so-called occlusion therapy is often carried out in addition. This involves taping off the healthy eye to help the squinting eye. This measure does NOT treat strabismus, but amblyopia (see above) of the affected eye.

Up to about eight degrees can sometimes be corrected with prism glasses, but this is only useful for certain strabismus diagnoses. If the misalignment is more pronounced, a strabismus operation may be necessary. In this case, we correct the eye muscles in order to at least significantly improve the eye position. The cause is usually the control system (by the brain), but the actuator muscle is operated on if there is no other possibility.

When is a strabismus operation necessary?

The treating ophthalmologist always decides individually if and when an operation is necessary. As a rule, a strabismus operation is recommended if the development of vision is disturbed or if there is pressure to suffer (e.g. double vision or a psychosocial indication) and if spectacle correction does not bring about sufficient improvement because the strabismus angle is too large. As a rule, the misalignment of the eyes should have remained constant over a longer full stop of time before a strabismus operation.

In children, it is recommended that the strabismus operation be performed before they start school, if possible, in order to avoid stressful situations in the school environment. In principle, however, an operation can also be performed at a later point in time - depending on the individual and the form of the strabismus. Sometimes it is necessary earlier. About 40% of people who have strabismus surgery are adults for a variety of reasons. Unfortunately, older people in particular experience being told - usually incorrectly - that "nothing can be done" about their double vision.

Procedure of the strabismus operation

Before the operation, several preliminary examinations are necessary, always the visual acuity, eye mobility, squint angle, organ findings and others. 

The operation takes place under general anaesthesia in children, in adults mostly under local anaesthesia with "twilight sleep". It is usually done on an outpatient basis, but sometimes an inpatient stay may be indicated. In this case, the doctor usually has a small "correspondence fight" with the so-called medical service. 

The muscles are reached by opening the conjunctiva. In our clinic, this is done almost exclusively with a special small incision technique, which results in a more tolerable wound healing and later a (often much) smoother scar. Muscles can be relocated, lengthened, folded and, if necessary, shortened to improve the position of the eye.  Under certain circumstances, this may require two, rarely more, operations or a correction on the healthy eye. 

After suturing the small conjunctival wounds, a bandage is applied to the eye for a few hours. You or your child can recover from the strabismus operation in our rooms.

What should be observed after the strabismus operation?

After the strabismus operation, dirt and hands should be kept away from the eyes. Drivers should not drive on the day of the operation.  The conjunctiva takes about five days to heal and the bruise will slowly disappear after two to four weeks. Local therapy should be dripped as directed. Ibuprofen is helpful for pain and has an anti-inflammatory effect. Please do not do any sports for 10 days and do not swim for 14 days. 

An ophthalmological check-up is the rule on the following day, if necessary in hospital or in the practice, if necessary also by "video consultation".  Slight pain cannot be avoided. In case of sudden severe pain or fever or increasing severe suppuration, you should contact your ophthalmologist immediately. As a rule, glasses must continue to be worn after the operation. 

What are the risks of strabismus surgery?

The strabismus operation is generally very low-risk. However, complications such as bleeding, infections or injuries to the eye structures can never be completely ruled out. Your attending doctor will inform you individually about the risks of surgery and anaesthesia before the operation. The main risk of a strabismus operation is usually "only" that you do not know the spontaneous individual development in the following months and years and decades. The squint angle can reappear - not necessarily in the same way - later or much later. That is why we always operate in such a way that we can correct it if necessary. 

Your questions will of course be answered individually.