Name of the Procedure:

Strabismus surgery (List separately in addition to code for primary procedure for patients with previous eye surgery or injury not involving the extraocular muscles)

Summary

Strabismus surgery is a procedure to correct misalignment of the eyes, which may cause double vision or impaired depth perception. This description specifically addresses cases involving patients with a history of eye surgery or injury that did not affect the extraocular muscles.

Purpose

Strabismus surgery aims to align the eyes properly to improve vision and appearance. The expected outcomes include eliminating double vision, enhancing binocular vision, and improving cosmetic appearance.

Indications

• Misaligned eyes (manifesting as crossed eyes, outward turning, upward turning, or downward turning)
• Double vision
• Eye strain or discomfort from misalignment
• An appropriate candidate with a history of eye surgery or injury that did not involve extraocular muscles

Preparation

• Patients may be advised to fast for several hours prior to the procedure.
• Adjustments to medications might be required, particularly blood thinners.
• Preoperative eye examination and imaging to assess eye muscle alignment and condition.
• Consent and discussion of the procedure, risks, and benefits.

Procedure Description

1. The patient receives anesthesia, which may be general or local with sedation.
2. The surgeon makes a small incision in the conjunctiva (the clear lining of the eye).
3. Depending on the misalignment, the surgeon will either shorten (resect) or reposition (recess) the eye muscles to achieve proper alignment.
4. The eye muscles are adjusted using delicate instruments and sutures.
5. The incisions are closed with dissolvable stitches, and an eye patch may be applied.

Duration

The surgery typically takes 1-2 hours, depending on the complexity and the number of muscles being addressed.

Setting

The procedure is performed in a hospital or an outpatient surgical center.

Personnel

• Ophthalmic surgeon specializing in strabismus
• Anesthesiologist or nurse anesthetist
• Surgical nurses and technicians

Risks and Complications

• Infection
• Over-correction or under-correction of the eye alignment
• Double vision
• Scarring
• Need for additional surgery
• Anesthesia-related risks

Benefits

• Improved eye alignment
• Enhanced vision and depth perception
• Reduction or elimination of double vision
• Better cosmetic appearance and social confidence Benefits can typically be realized within a few weeks post-surgery.

Recovery

• Use of prescribed eye drops or ointments to prevent infection and reduce inflammation.
• Avoiding strenuous activities and swimming for a few weeks.
• Follow-up appointments to monitor alignment and healing.
• Some discomfort and redness are common but usually subside within a few weeks.

Alternatives

• Prismatic glasses to improve vision alignment
• Eye muscle exercises, although these might not be effective for all types of strabismus
• Botulinum toxin injections to temporarily weaken overactive muscles
• Pros: Non-surgical options are less invasive and have fewer immediate risks.
• Cons: They may provide temporary or limited results compared to surgery.

Patient Experience

During the procedure:

• The patient is under anesthesia and will not feel pain. After the procedure:
• Mild discomfort, redness, and swelling in the eye
• Some patients experience temporary double vision, which usually resolves within days to weeks.
• Pain can be managed with over-the-counter pain relievers and prescribed eye medications.