Name of the Procedure:

Strabismus surgery on patients with scarring of extraocular muscles or restrictive myopathy (e.g., prior ocular injury, strabismus or retinal detachment surgery, dysthyroid ophthalmopathy).

Summary

Strabismus surgery involves repositioning the eye muscles to improve eye alignment and coordination in patients who have scarring or restrictive myopathy affecting extraocular movements.

Purpose

Strabismus surgery aims to correct misaligned eyes due to scarring from previous ocular injuries or surgeries or due to restrictive conditions like dysthyroid ophthalmopathy. The goals are to restore binocular vision, improve depth perception, relieve double vision, and enhance aesthetic appearance.

Indications

• Persistent eye misalignment despite non-surgical treatments.
• Double vision (diplopia).
• History of scarring from previous ocular surgeries or injuries.
• Restricted eye movements due to conditions like dysthyroid ophthalmopathy.
• Functional issues resulting from misaligned eyes.

Preparation

• Comprehensive eye examination and medical history review.
• Imaging studies (e.g., MRI, CT scans) to assess muscle scarring or restriction.
• Fasting for 6-8 hours prior to surgery, if general anesthesia is required.
• Adjustments or cessation of certain medications as advised by the surgeon.

Procedure Description

1. Anesthesia: The patient is given either general anesthesia or local anesthesia with sedation.
2. Access: A small incision is made on the conjunctiva (the clear tissue covering the white part of the eye).
3. Muscle Adjustment: The surgeon identifies and isolates the involved eye muscles. Scar tissue is meticulously dissected and new muscle attachment points are created.
4. Repositioning: The muscles are repositioned to correct the alignment, often using adjustable sutures.
5. Closure: Incisions are closed with dissolvable stitches, and an antibiotic ointment is applied.

Duration

The procedure typically takes 1 to 2 hours.

Setting

Strabismus surgery is usually performed in a hospital or an outpatient surgical center.

Personnel

• Ophthalmic surgeon (specialized in strabismus).
• Anesthesiologist.
• Surgical nurses.
• Operating room technicians.

Risks and Complications

• Infection.
• Bleeding.
• Over- or under-correction of eye alignment.
• Misalignment recurrence.
• Unintended trauma to surrounding eye structures.
• Scarring at new muscle sites.
• Anesthesia-related risks.

Benefits

• Improved eye alignment.
• Enhanced cosmetic appearance.
• Better binocular vision and depth perception.
• Relief from double vision. Benefits are often realized within weeks after surgery.

Recovery

• Patients may experience mild discomfort and redness for a few days.
• Application of antibiotic eye drops or ointments to prevent infection.
• Avoid strenuous activities for 1-2 weeks.
• Follow-up appointments to monitor healing and alignment.
• Use of adjustable sutures may require post-operative adjustments.

Alternatives

• Prism glasses to correct vision alignment.
• Botulinum toxin injections to temporarily adjust muscle strength.
• Vision therapy and exercises.
• Pros include less invasiveness for non-surgical options; cons include potentially less effective results in severe cases.

Patient Experience

• Some discomfort and minor pain post-procedure managed with prescribed pain relievers.
• Possible temporary redness and swelling in the eye.
• Vision might be blurry but improves as healing progresses.
• Post-operative adjustments and follow-ups ensure proper alignment and recovery.