Squint Surgery

Squint Surgery

For most squints or cross-eyes, the only way to treat them is by performing a squint surgery.  Yes, most squint and not all. One of the squints not treated by surgery is accommodative esotropia.  Some of the more common questions we get asked when we advise a squint eye surgery are what are the risks of a squint operation and what is the squint eye surgery cost in Mumbai.  More on that later.

What happens in a squint eye surgery ?

We as squint specialists or strabismologist move the muscles of the eyes.  The muscles are known as extraocular muscles. These muscles are responsible for moving our eyes up down left and right.  There are 6 muscles in total and we may choose to operate on one or more of them.

We will go ahead and describe a squint surgery in a little more detail.  Before surgery, your squint specialist would do a detailed squint consultation.  During this consultation, we would know the measurement of the squint and the type of squint.  Depending on these two factors a decision would be made on which muscles to operate and by how much to move them.

The decision on how much to operate is made taking the help of certain charts or nomograms.  These are charts which are made and of course changed many times over the past many years by experiences of a large number of squint surgeries.  In other words, these tell us if one muscle is moved by let's say 5mm, this is the amount the eye will move by.  

On the day of surgery, the first step is to identify the muscle and then to pass sutures through the muscle.  Once that is done the muscle is detached from the eyeball. In other words, the natural junction of the muscle and the eyeball is cut.  The muscle is then sutured to the eyeball at a new position. This happens for each muscle that is going to be operated upon.  

What kind of anesthesia is used for this squint eye treatment ?

For squint surgeries, we use either local or general anesthesia.  Local anesthesia is used for adults and general anesthesia is used for children.  There is no well-defined age here. If for eg someone is 19 years old and wants a squint surgery but is too scared to get an eye injection then we would consider doing the surgery under general anesthesia.  On the other hand, we have operated on 17-year-olds under local anesthesia because they were not afraid to take the eye injection of local anesthesia.

What is the best age for squint eye surgery ?

This is another common question.  Can we do the surgery on a 1 or 2-year-old child?  Or is there an age limit for squint surgery? In general squint, surgeries are not done before 10-12 months of age.  So that is a younger age limit. After that technically a squint surgery can be performed. But your squint specialist cannot jump into surgery on seeing a squint.  Different types of squint are treated at different times. A squint from birth is treated early. A squint that is acquired is treated later sometimes many years after the parents first notice the squint.  

Regarding operating on adults a squint surgery can be done at any age.  Yes, we have operated on 50-year-olds who do not want to live with the squint anymore.  

What is adjustable squint surgery ?

We mentioned earlier that we take the muscle from its original position and suture it in its new position.  We do this by using sutures or tying material. We all know how to tie knots. One can tie permanent knots or tie knots like we do when we tie our shoelaces.  More often a permanent knot is used to tie the muscles to their new position. In an adjustable squint surgery, a shoelace knot is used. Once this temporary knot is tied we see the patient again the next day and if we feel we have to adjust the position of the muscle we actually untie that knot and more the muscle and retie the knot.  We are thus able to adjust the position of the muscle even after doing the squint surgery and thus this is known as adjustable squint surgery

This surgery will not benefit younger patients because they won’t be able to cooperate with us during the adjustment part of the squint eye treatment the next day.

What are the risks of Squint Operation ?

Mostly a squint operation is quite a safe procedure.  That being said there is one thing that can go wrong during squint surgery.  Now, as mentioned earlier we move the muscle to a new position. We do that by suturing the muscle to its new position.  This suturing is done by a needle that is attached to the thread. We have to pass the suture through the wall of the eye making sure that we are within the thickness of the wall.  This wall is also known as the sclera and is the white part of the eye. It is possible that when your squint surgeon is taking this suture his needle may go the full thickness of the eyeball.  In other words, it’s like poking a needle in the eye. This is known as globe perforation and is not a good complication to have. That being said there are immediate and very effective treatments that can be done that would take care of this complication.  Apart from this one complication, there are a few others that are so rare and it's not worth mentioning them here.

What are the precautions after Squint Surgery ?

Squint surgery is extraocular surgery.  What that means is that we don’t go into the eyeball during this surgery.  The walls of the eyeball remain intact. Because of that, the risks of eye infections post this surgery are almost nil.  The restrictions therefore and not very rigid. At eye solutions, we advise our patients to not take a head bath for the next 2 days after surgery.  We also prescribe and give them certain eye drops and eye ointments which are to be used for 3-4 weeks.

The eyes turn red after the squint surgery and may remain so for upto 3-4 weeks.  This is not something to be alarmed about but is something that we expect.

What is the success rate of Squint Surgery ?

Usually when strabismologist the world over operate they give a success rate of about 80%.  For some squint treatments, the rate may be higher and for a fewer number, the rate may be lower.  What this means is that there is a 20% chance that a second surgery may be needed a few years down the line.  Yes, a squint surgery can be repeated without any risks. There actually are certain risks but all squint surgeons are aware of these risks and thus take steps to avoid them.   So yes a second and third squint surgery can be attempted without risks.

What happens after Squint eye Treatment ?

Apart from the eye drops and ointment one has to use the eyes to appear straight or almost straight after surgery.  At Least that is the result we are hoping for. Most of the time the families cannot appreciate this new corrected position because the eyes are red after the squint operation.  Gradually as the redness decreases members of the family start appreciating that the position of eyes has changed.

There is a possibility that the patient may see double after the squint surgery.  Most of the time this settles down as the eyes and vision adjust to the new position.  Sometimes this does not go away and your eye specialist may have to prescribe you glasses to get rid of the double vision.

What is the cost of Squint eye surgery in India ?

As mentioned earlier this is a very common question we get asked.  The cost of squint surgery varies greatly in India. Even Mumbai for that matter.  It would depend on the type of squint, the number of muscles that your squint specialist is operating upon.  It would also depend on the complexity of the squint. Finally, it would depend on the expertise of your eye doctor.  Squint specialists may be more expensive than eye doctors who have not specialized in treating squints.  

At Eye Solutions our squint charges range from Rs 70000 to Rs 135000 depending on the above-mentioned factors. 

What is post Surgery care ?

The eye is bandaged for a few hours on the day of surgery.  The best squint specialists in Mumbai sometimes do what is known as ‘adjustable squint surgeries’.  Here the eye may be patched for a day.  Read more about this in squint surgery.

After surgery, eye drops are prescribed and follow-up visits advised.

The treatment does not stop with surgery. Glasses may have to be continued to maintain clarity of vision. Patching therapy may be needed to be continued for some time after the surgery and is done to treat amblyopia or a lazy eye.

With early detection, accurate diagnosis and proper treatment, the prognosis with strabismus treatment is excellent.

Frequently Asked Questions ?

What Happens after the operation ?
It is a day Care Surgery with no hospitalization. The eye pad is removed the same day or sometimes the next day and eye drops are instilled a few times a day for the next few weeks. Since it is an external surgery there is no effect on the vision. Most of the times external sutures are absorbable and do not have to be removed. Though the eyes may be red initially but a person can join back his work in a couple of days.

Will more than one surgery be needed ?
It is not uncommon for more than one operation to be necessary. This does not mean that something has gone wrong but that fine-tuning is needed to obtain the best straight alignment. Sometimes the Squint is too Large and second surgery can be planned.

When your child is having strabismus surgery?
You are probably reading this because your child’s doctor has recommended surgery to improve your child’s eye turn. You would be expected to reach hospital at the alloted time and your child should be fasting because the surgery will happen under general anesthesia. Depending on the number of muscles to be operated the surgery can take anywere between 30 minutes to a little more than an hour. Post surgery your child will be a little drowsy because of the drugs that have been administered and that is ok.

One of both eyes may be patched depending upon which eye is operated. The patches are usually removed a few hours after surgery and the drops are started. The drops are usually administered 4-6 times a day for 4 weeks.

The eyes may be red, sometimes quite red and that is fine and there is nothing to worry. The redness usually subsides a few weeks post the surgery.

What is done in strabismus surgery?
In strabismus surgery the weak muscles are tightened and the tight muscles are loosened so that the eyes now have a better position. The surgery is done under general anesthesia in children. Only the muscles attached on the outer surface of the eyeball are dealt with making this an extra-ocular surgery and thus a very safe surgery. No skin around the eye is cut thus there will be no scars after the surgery. No lasers are used. Absorbable sutures are used during the surgery and will not need removal.

What should I expect my child’s eye to look like after the surgery?
Your child’s eye may or may not be patched after the surgery. If the eye is patched it may be removed by the nurse before discharge. Sometimes the patch is required for longer and you are sent home with the patch on the child’s eye. Your doctor will inform you as to when should the patch be removed.

If your child’s eye is not patched or once the patch is removed, the eyes may appear slightly swollen or red. This may persist for a few weeks. The swelling starts to decrease first followed by the redness.

Your child may experience some discomfort or pain in the operated eye. This is nothing to get anxious about and is normal. Your doctor will advise you some medication for the same.

Sometimes children may complain of double vision after the surgery. This usually disappears once the child gets used to the new position of his or her eye muscles.

Your child may have pinkish tears or blood tinged tears coming from the eye for a few days after the surgery. Again this is not something that you should get worried about. This discharge from the eyes will gradually decrease over the next few days after surgery.

What the post operative instructions that I need to follow?
Your child’s doctor will prescribe antibiotic eye drops and sometimes an eye ointment for the operated eye. You will be required to use the medications as advised. Usually these medications are continued for a maximum period of one month.

For a week after the surgery rough outdoor activities like playing outdoors or contact sports should be avoided. Swimming should also be avoided for 3 weeks after surgery. Your child however could watch TV, use the computer and play some light games at home.

You should avoid giving your child a head bath for a few days after the surgery. A bath below the neck can be given. The face can be wiped with a wet cloth. You should take care not to let water, soap or shampoo enter the eye.

You must also remember that if the redness increases, if the pain increases and if your child complains of decrease in vision then you must bring the child immediately to your child’s doctor.

When does my child need to be seen after the surgery?
Your child’s doctor will advise you as to when the child has to be seen at the clinic. Usually the child is seen the next day after the surgery. After that the child may be seen after one week or directly after one month.

Will my child need glasses or patching after the surgery?
Usually surgery does not change the need for glasses or patching after the surgery. If your child was wearing glasses before the surgery there is a high probability that he or she will wear glasses after surgery. Sometimes surgery forms only part of the treatment for your child’s eye condition. Yes patching may be required after the surgery too. It depends on how good the vision is in each eye. What the squint surgery has done for you is to only align the eyes.
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