Strabismus Surgery: A Complete Guide

Medically Reviewed By Sara N. Frye, OD, MPH, FAAO

Strabismus surgery is used to fix misalignment of the eyes, also known as a squint. It involves adjusting the position of an eye muscle so that the eyes can point and move in the same direction. Strabismus is an eye disorder where the eyes do not align with each other when looking at something. For example, when looking at an object, one eye may be turned in a direction different from the other, such as up, down, inward, or outward. Some people may refer to strabismus as “crossed eyes.”

Your eye doctor may recommend strabismus surgery if other treatments have not helped effectively. This can be an effective way of realigning the eyes and improving coordination.

This article explains the uses, procedure, recovery, and effectiveness of strabismus surgery.

What is strabismus surgery for?

An eye doctor examines the eyes using a slit lamp.
Sergio Marcos/Stocksy United; kolderal/Getty Images

Strabismus surgery treats an eye disorder called strabismus, a misalignment of the eyes. It is a common condition, particularly among children.

Six muscles attach to each eye, working together to control its movement. Each of these six muscles controls a different direction, such as up or down. With strabismus, one or more of the muscles may not work with the others properly to align vision. This can lead to weaker vision in the affected eye.

Surgery can move the affected muscles, helping to improve eye movement control and alignment.

Doctors may recommend strabismus surgery after trying other treatment options first, such as:

  • eyeglasses
  • eye patches
  • eye drops
  • vision therapy

Learn more about strabismus, including its symptoms, causes, and other treatments.

How do you prepare for strabismus surgery?

Your medical team will provide personalized advice on preparing for your strabismus surgery.

You will likely have a pre-operation assessment where doctors make sure you are fit to have surgery and answer any questions. This can involve:

  • a comprehensive eye exam
  • a general health check
  • reviewing your medical history and current medication and supplements with doctors
  • an appointment with an anesthetist

Other ways your medical team may ask you to prepare include:

  • not eating or drinking anything other than clear fluids from the day before the operation
  • arranging transport to get home, as you will not be able to drive after surgery
  • asking a trusted friend or family member to help you during the first few days of recovery
  • bringing any glasses you wear on the day of the operation

What is the procedure for strabismus surgery?

You will receive anesthesia before the procedure starts to avoid pain and discomfort. The type of anesthesia your doctors use may depend on your health and age, but it can include local anesthesia with sedation or general anesthesia.

Surgeons will start the procedure by making a small cut to the white of the eye, or sclera, which covers the eye’s muscles. They will then use tools to identify the muscles that need adjusting.

Depending on your condition, the surgeon will then choose one of a few different techniques:

  • Recession: A recession procedure is used to loosen tight muscles, reducing tension in the eye. To do this, the surgeon will cut the muscle from the eye’s surface and stitch it to the eye in a new location further backward, causing the muscle to be less stretched.
  • Resection or plication: This procedure can help strengthen weakened eye muscles. Your surgeon will shorten the muscle by either removing part of it or folding it over and sewing the new end of the muscle back into the original position to tighten it.

Sometimes surgeons use an adjustable suture to reattach the muscle in its new position. An adjustable suture involves securing the muscle in its new position with a temporary knot under local anesthesia. This means that, if necessary, a surgeon can alter the by adjusting the knot on the same day as the operation or a few days later. Doctors may be more likely to use an adjustable suture if:

  • you have had a strabismus operation before
  • you have a high risk of double vision
  • you have a strabismus due to injury or thyroid-related eye problems

Surgery without adjusting your suture may take about an hour, depending on how many muscles need alignment.

An illustration of strabismus surgical procedures.
Doctors may use different surgical procedures, depending on the type of strabismus you experience.
Illustration by Mekhi Baldwin.

What is recovery like after strabismus surgery?

After the surgery, you will be taken to a recovery room so that doctors can monitor your condition while the anesthesia wears off.

Your medical team will give you personalized guidance on care during recovery. They may recommend or request:

  • avoiding certain activities, such as driving or strenuous activity
  • taking time off work or school
  • coming in for a checkup appointment
  • using prescription eye drops to prevent infection
  • avoiding wearing contact lenses for several weeks
  • avoiding using makeup or facepaint on or around the eyes for several weeks
  • taking over-the-counter or prescription pain relief medication to alleviate discomfort
  • making sure children undergoing strabismus surgery do not play in sand or dirt

According to the American Academy of Ophthalmology, most children and adults can return to their usual daily routine within a few days.

In some cases, your doctors may recommend vision therapy to further support eye coordination and alignment after surgery.

During recovery, you may experience eye redness or feelings of scratchy or sore eyes with eye movement. Symptoms typically improve within several days, but it can take weeks or months for eye redness to completely go away.

Talk with your medical team as soon as possible if you notice any new, worsening, or persistent symptoms or symptoms that feel concerning after strabismus surgery.

Seeing a doctor for eye symptoms is an important following surgery. Learn more about when to see them.

How effective is strabismus surgery?

The effectiveness and outlook after strabismus surgery can vary per person, depending on factors such as:

  • your strabismus type
  • your surgery type
  • your age, underlying health, and other factors that can impact the safety and effectiveness of surgery

For example, some experts suggest that strabismus surgery can lead to improvements in strabismus in up to 90% of cases overall. However, researchers from a 2017 study Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source suggest that surgery for horizontal strabismus is successful in around 60–80% of cases. It’s important to note that the 2017 research involved specific parameters for data collection and analysis.

Often, people need further surgery to completely correct strabismus, especially if it is severe. Strabismus misalignment can also shift from one eye to the other, contributing to the need for further surgery.

As each person’s eyes and strabismus may differ, the adjustments needed can be highly personal. Surgeons may need to update their adjustments to ensure they are right for you.

A 2018 analysis of strabismus surgery in the United States suggested that 1 in 15 people underwent repeat operations to readjust strabismus. In the analysis, the chances of undergoing further operations increased with age.

Strabismus surgery does not fix the need for eyeglasses or patches. You may also continue to have blurring after strabismus surgery if you experienced it before.

What are the risks of strabismus surgery?

As with all procedures, strabismus surgery can have risks and complications, such as:

  • permanent double vision requiring special glasses
  • infection
  • allergy to provided medications
  • eye muscles moving out of position, requiring further surgery
  • eye damage, such as a small hole made in the eye from stitching, requiring antibiotics and a procedure to fix the hole
  • in rare cases:
    • larger pupil in the eye your doctor operated on
    • poor circulation in the operated eye
    • infection
    • eye scarring
    • bad reactions to anesthesia, which can be fatal
    • vision loss, which is particularly rare

Summary

Strabismus surgery is a procedure to help fix the misalignment of the eyes, known as strabismus or a squint. It involves readjusting the muscles that help control eye coordination by making a small incision to the outer eye and moving the muscle positions.

Talk with your eye doctor if you have any questions about strabismus surgery or experience new or concerning symptoms after the procedure.

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Medical Reviewer: Sara N. Frye, OD, MPH, FAAO
Last Review Date: 2024 Feb 14
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