Detecting Strabismus

Strabismus can cause crossing, drifting out, or drifting up of an eye.

Six Muscles of the Eye

Misalignment of the eyes, known as strabismus, is a common problem in childhood. Strabismus is usually recognized by parents as a crossing or drifting out of one or both eyes. The drifting may be constant or intermittent. An examination by your pediatrician or eye doctor can confirm whether strabismus is present. The risk of strabismus is much higher when a family history of "lazy eye" or crossed eyes is present.

Children do not outgrow crossing
Many parents have been told that their child will outgrow crossing of the eyes. This is simply not true. It is normal for the eyes of infants up to four months of age to cross or drift out. However, after this time, eyes should be straight at all times. If you see drifting of the eyes after four months of age, bring this to the attention of your pediatrician or eye doctor.

What causes strabismus?
Six small eye muscles control the movement of each eye. The brain's delicate control over these muscles allows the eyes to track together in all directions of gaze. Somechildren are born with an imbalance of this control, causing the eyes to cross or drift. Precise control of all six eye muscles is necessary for proper tracking and alignment of the eyes.

Eye Muscle surgery
Eye muscle surgery is a simple outpatient procedure. The eye is not removed from the orbit, nor are any lasers used during surgery. The procedure generally takes less than an hour to complete. In all children and in most adults, eye muscle surgery is performed under general anesthesia. After the patient is put to sleep, the thin clear tissue covering the eyeball is peeled back to give the surgeon access to the muscles that move the eye. Depending on the underlying problem, the muscles may be strengthened or weakened. For instance, in a patient with turning in of the eyes, the muscles that pull the eyes in are surgically weakened. Because the surgery is completed without ever entering the eyes, the risks involved are extremely small. During surgery, the eye muscle is disinserted and placed in a new position to restore the alignment of the eyes.

Pre-Op Muscle	Post-Op Muscle

Commonly Asked Questions About Eye Muscle Surgery

How long does it take?
The surgery itself usually takes between thirty to sixty minutes to complete.

What is the recovery time after surgery?
Children are usually back to school and adults back to work within a few days.

Do you take the eye out of the head and put it back during surgery?
No. The surgery is done with the lids held open, with the eye in its normal position.

Are there any scars after surgery?
The surgical incision is made through the thin tissue covering the white part of the eye. In nearly all cases, the healing hides the scar so it can hardly be seen. Incisions are never made through the skin.

What are the goals of surgery?
The primary goal is to restore straight eye alignment. In patients with double vision, the goal is to reduce the double vision as much as possible. Many patients also benefit from improved cosmetic appearance.

Is a patch worn after surgery?
Generally not. On occasion, a patch is used for the night after surgery.

Can eye muscle surgery be completed in adults?
Yes. Eye muscle surgery is safe in adults and children alike.

What is the chance of needing a second operation?
The likelihood of needing a second operation depends largely upon the problem for which the surgery is being done. Many eye muscle problems can be taken care of with one operation while others will likely need two or more surgeries.

Is recovery painful?
No. After surgery, the eyes feel "scratchy", but not very painful.

What is an adjustable suture?

In some adolescents and adults, an operated muscle can be secured with an adjustable suture. When the patient is under general anesthesia, the stitches to that muscle are tied with a bowknot. When the patient wakes up, the knot is untied and adjusted to "dial in" the muscle to the best possible position. This is performed the morning following surgery using numbing drops to minimize discomfort. I do not recommend the use of adjustable sutures in young children.