Strabismus Surgery (Eye Muscle Surgery): The Procedure, Recovery & Outcomes

Eye muscle surgery, also called squint surgery, is a procedure that adjusts the muscles in people with strabismus. Strabismus is commonly called lazy eye or crossed eyes.

Strabismus has many known causes. In many patients, its cause is unknown, resulting in one eye drifting in one direction, with vision problems developing as the brain adapts to the shift. 

Types of Strabismus Surgery Can Treat

Eye muscle surgery can generally treat any moderate-to-severe case of strabismus. However, many mild cases of the condition may not require surgery. 

The initial recommended treatment is to wear corrective eyewear and cover the dominant eye with a patch. This can sometimes make surgery unnecessary. 

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Who Is a Candidate for Eye Muscle Surgery?

Strabismus of all kinds generally coincides with amblyopia, where the brain has learned to favor one eye over the other. Eye muscle surgery alone doesn’t fix the poor vision caused by this condition. Additionally, a person can develop strabismus again if amblyopia or any other source of vision loss isn’t first dealt with. 

For this reason, a doctor will first work with a patient to correct any vision problems. Then, the doctor will work with the patient to decide if surgery is the best option as part of a larger treatment plan.

What Is the Best Age for Strabismus Surgery?

While eye muscle surgery is an option for patients of all ages, it is notably more successful for children under 11. Ideally, anyone with strabismus gets help for it while they are young. Retraining the brain and muscles to work in unison is often easier when the brain is still developing. 

If treatment is delayed, some patients may experience permanent vision loss. At present, amblyopia often becomes permanent if not treated before the age of 11. While promising research is being done in the area, it is better to get strabismus treated as soon as it is detected.

Preparation for Eye Muscle Surgery

As with any surgery, follow all pre-surgery recommendations laid out by a doctor.

A patient preparing for eye muscle surgery cannot take certain medications for about 10 days leading up to their surgery. These medications include the following:

• Aspirin
• Ibuprofen
• Warfarin
• Any other medication that thins the blood

A doctor may also prescribe certain medications to be taken the day of the procedure, as they feel is most appropriate. On the day of your or your child’s surgery, there are some common best practices that more broadly apply to surgery in general that you should follow:

• Don’t eat or drink for several hours before the surgery unless told otherwise by your surgeon’s office.
• Make sure to take all prescribed medications at the right time, with a small sip of water.
• Arrive at the surgery facility on time or early.
• Monitor your health and alert your doctor of any signs of illness, even if they seem mild.

Strabismus Surgery: The Procedure

The goal of eye muscle repair surgery is to rebalance the strength of the six muscles in your eye. 

Doctors usually use general anesthesia for children, putting them asleep. For adult patients, a doctor may use localized anesthesia. Medication is applied to the site of the surgery and administered orally to keep the patient relaxed and pain-free.

Once the patient is ready, the surgeon makes a small surgical cut into the conjunctiva. This is the thin membrane that covers the inner surface of the eyelid. Through this cut, they can access the muscles that need adjusting.

Strengthening a muscle usually requires resection, where a surgeon removes part of the muscle to make it shorter (and thus tighter). Weakening a muscle involves reattaching a muscle farther back, loosening it. This is called recession.

In adult patients, a surgeon may use an adjustable stitch on weakened muscles. This allows for changes to be later or the following day if they deem minor adjustments necessary.

Recovery

The recovery period for eye muscle surgery is fairly short. A patient can often leave the hospital on the same day. 

The eyes should appear straight, although it is important that a patient avoids rubbing their eyes as they heal and the anesthesia wears off. 

Patients often need to use prescribed medicated eye drops for about a week as they recover. These drops (or sometimes ointment) are antibiotics and help prevent infection. A follow-up visit will be scheduled a week or two after the surgery to make sure the patient is recovering as expected.

Most patients will have fully healed from the procedure within about three weeks.

Outcomes of Eye Muscle Surgery

The prognosis for strabismus surgery is very good in children. Aesthetically, the eye is likely going to be straight immediately after the surgery. With proper attention and adherence to doctor recommendations, amblyopia is also likely to go away. 

Note that this procedure doesn’t fix any associated vision problems beyond those caused by strabismus. Many patients still need glasses after surgery.

In older children, teens, and adults, eye muscle surgery can still straighten their eye. However, the patient may still experience amblyopia, as their brain struggles to relearn how to use both eyes now that they are aligned. 

Risks of Strabismus Surgery

Major complications from eye muscle surgery are rare, but a mistake during eye surgery is always a remote possibility and could cause permanent damage. It is also possible, in rare cases, that a patient develops permanent double vision. 

Much more common are complications as a result of bleeding or infection. Surgery can expose weaker elements of the eye to bacteria. However, doctors know this and can react accordingly. 

If you notice any pain, itchiness, irritation, vision problems, or any other complication that seems out of the ordinary, inform your doctor immediately. Prompt treatment can prevent major issues.

Because this procedure involves anesthesia, complications are possible. Anesthesia can sometimes cause breathing problems, and some people may have negative reactions to it. Make sure your doctor knows ahead of time if you have any known allergy to anesthesia or have experienced complications from it in the past.

Insurance Coverage for Eye Muscle Surgery

Eye muscle surgery isn’t just a cosmetic procedure, so it is usually covered by health insurance plans. The procedure is an important part of treating the vision problems caused by strabismus, especially in children.

Newer or experimental procedures may or may not be covered, especially those newer procedures aimed at adults. Discuss your options with your doctor and insurance provider to determine the best choice for you. In many cases, a doctor can persuade a provider to cover a procedure that is not normally covered if they can argue there is no medically valid alternative.

References

1. Amblyopia. MedlinePlus.

2. Amblyopia. (January 2022). StatPearls.

3. Aspirin in Patients Undergoing Noncardiac Surgery. (April 2014). The New England Journal of Medicine.

4. Contractile Force of Human Extraocular Muscle: A Theoretical Analysis. (March 2016). Applied Bionics and Biomechanics.

5. Conjunctiva. (September 2019). MedlinePlus.

6. Eye Muscle Repair. (August 2020). MedlinePlus.

7. Strabismus. (August 2020). MedlinePlus.

8. Prognostic Preoperative Factors for Successful Outcome of Surgery in Horizontal Strabismus. (May–August 2017). Oman Journal of Ophthalmology.

9. Complications of Strabismus Surgery. (July–September 2015). Middle East African Journal of Ophthalmology.

10. Extraocular and Intraocular Infections Following Strabismus Surgery: A Review. (April 2019). Journal of Pediatric Ophthalmology & Strabismus.