Strabismus (Squint) Surgery: A Complete Guide

Introduction to Strabismus (Squint)

Strabismus, commonly known as squint or crossed eyes, is a condition where the eyes do not align properly. One eye may turn inward, outward, upward, or downward while the other focuses normally. This misalignment can lead to double vision, depth perception issues, and even amblyopia (lazy eye) if left untreated.

While glasses, vision therapy, or patches can help in some cases, strabismus surgery is often recommended when conservative treatments fail. This procedure adjusts the eye muscles to restore proper alignment, improving both vision and appearance. For many patients, especially children, early intervention can prevent long-term vision problems.

In this guide, we’ll explore everything you need to know about strabismus surgery—from causes and symptoms to recovery and success rates.

Causes and Symptoms of Strabismus

Strabismus can develop due to various factors, including:

• Genetic predisposition (family history of strabismus)
• Neurological conditions (e.g., cerebral palsy, stroke)
• Refractive errors (uncorrected farsightedness)
• Trauma or injury affecting eye muscles or nerves
• Childhood illnesses (e.g., retinoblastoma, Down syndrome)

Symptoms may include:

• Eyes that visibly point in different directions
• Frequent squinting or tilting the head to see better
• Double vision (diplopia)
• Eye strain or headaches
• Poor depth perception (difficulty judging distances)

If you notice these signs—especially in children—consult an ophthalmologist for an evaluation. Early diagnosis improves treatment outcomes.

When is Surgery Needed?

Strabismus surgery isn’t always the first-line treatment. Doctors typically recommend it when:

• Non-surgical treatments fail: If glasses, prisms, or vision therapy don’t correct alignment.
• Large-angle strabismus exists: Severe misalignment often requires surgical correction.
• Cosmetic concerns affect quality of life: Adults and older children may seek surgery for improved appearance.
• Double vision persists: Chronic diplopia can be debilitating.

Children often undergo surgery between ages 2–6 to prevent amblyopia, while adults may opt for it at any age. Your ophthalmologist will assess eye health, muscle function, and overall suitability before recommending surgery.

Preparing for Strabismus Surgery

Proper preparation ensures a smooth procedure and recovery:

• Pre-operative evaluation: Comprehensive eye exams, blood tests, and imaging (if needed).
• Medication adjustments: Discontinue blood thinners (aspirin, ibuprofen) as advised.
• Fasting: No food or drink 6–8 hours before surgery (for general anesthesia).
• Arrange transportation: You’ll need someone to drive you home post-surgery.
• Discuss anesthesia: Children usually get general anesthesia; adults may use local anesthesia with sedation.

Ask your surgeon about post-op care supplies (eye drops, patches) and follow all pre-surgery instructions carefully.

The Surgical Procedure: Step-by-Step

Strabismus surgery typically takes 1–2 hours and involves:

1. Anesthesia: Administered to ensure comfort (general or local).
2. Incision: A small cut in the conjunctiva (clear tissue covering the eye).
3. Muscle adjustment: The surgeon tightens, loosens, or repositions eye muscles using sutures.
4. Closure: The conjunctiva is stitched back (dissolvable sutures often used).

Recovery begins immediately, though vision may be blurry initially. Most patients go home the same day.

Recovery and Post-Operative Care

Post-surgery care is crucial for healing:

• First 24–48 hours: Rest, avoid rubbing eyes, and use prescribed antibiotic drops.
• Pain management: Mild discomfort is normal; use acetaminophen (avoid aspirin).
• Activity restrictions: No swimming or heavy lifting for 2–4 weeks.
• Follow-up visits: Scheduled to monitor healing and alignment.

Most patients resume normal activities within 1–2 weeks, though full recovery may take 4–6 weeks. Redness and swelling subside gradually.

Risks and Possible Complications

While strabismus surgery is generally safe, potential risks include:

• Over-/under-correction: May require additional surgery.
• Infection: Rare but possible (prevented with antibiotic drops).
• Double vision: Usually temporary but may persist in rare cases.
• Scarring: Minimal due to modern techniques.

Discuss concerns with your surgeon—most complications are manageable with prompt care.

Success Rates and Expected Outcomes

Strabismus surgery has a high success rate:

• 80–90% of patients achieve improved alignment.
• Children often regain binocular vision if treated early.
• Adults report enhanced confidence and social interactions post-surgery.

While some cases need touch-up procedures, most enjoy lasting results. Realistic expectations are key—perfect alignment isn’t always possible.

FAQs About Strabismus Surgery