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Eye muscle repair

Eye muscle repair is surgery to correct eye muscle problems that cause crossed (misaligned) eyes. The medical term for crossed eyes is strabismus .

The goal of this surgery is to allow the eye muscles to be in proper position and help the eyes move correctly.

Eye muscle surgery is usually done on children, but adults who have similar eye problems may also have it done. Children will usually receive general anesthesia for the procedure. They will be asleep and will not feel pain.

Depending on the problem, one or both eyes may have surgery.

After the anesthesia has taken effect, the eye surgeon makes a small surgical cut in the clear tissue covering the white of the eye. This tissue is called the conjunctiva . Then the surgeon will locate one or more of the eye muscles that needs surgery. Sometimes the surgery strengthens the muscle, and sometimes it weakens it.

  • To strengthen a muscle, a section of the muscle or tendon may be removed to make it shorter. This step in the surgery is called a resection.
  • To weaken a muscle, it is reattached at a point farther toward the back of the eye. This step is called a recession.

The surgery for adults is similar. Most adults are usually awake and sleepy, but pain free. Numbing medicine injected around the eye blocks the pain.

Often in adult surgery, an adjustable suture is used on the weakened muscle. Minor corrections can be made later that day or the next day, when the patient is fully awake. This technique usually has a very good outcome.

Alternative Names

Repair of cross-eye; Resection and recession; Strabismus repair; Extraocular muscle surgery

Why the Procedure Is Performed

Strabismus is a disorder in which the two eyes do not line up in the same direction and therefore do not look at the same object at the same time. The condition is more commonly known as "crossed eyes."

Surgery may be recommended when strabismus does not improve with glasses or eye exercises.

Risks

Risks for any anesthesia are:

  • Reactions to anesthesia medicines
  • Breathing problems

Risks for any surgery are:

  • Bleeding
  • Infection

Some other possible complications are:

  • Wound infections
  • Damage to the eye (rare)
  • Permanent double vision (rare)

Before the Procedure

Your child's eye surgeon may ask for:

  • A complete medical history and physical exam of your child before the procedure
  • Orthoptic measurements (eye movement measurements)

Always tell your child's doctor or nurse:

  • What drugs your child is taking
  • Include any drugs, herbs, or vitamins you bought without a prescription
  • About any allergies your child may have to any medicines, latex, tape, or soaps or skin cleaners

During the days before the surgery:

  • About 10 days before the surgery, you may be asked to stop giving your child aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other drugs that make it hard for blood to clot.
  • Ask your child's doctor which drugs your child should still take on the day of the surgery.

On the day of the surgery:

  • Your child will usually be asked not to drink or eat anything for several hours before the surgery.
  • Give your child any drugs your doctor told you to give your child with a small sip of water.
  • Your child's doctor or nurse will tell you when to arrive for the surgery.
  • The doctor will make sure your child is healthy enough for surgery and does not have any signs of illness. If your child is ill, the surgery may be delayed.

After the Procedure

This surgery is usually done on an outpatient basis. The eyes are usually straight right after surgery.

While recovering from the anesthesia and in the first few days after surgery, your child should avoid rubbing the eyes. Your surgeon will show you how to prevent rubbing.

After a few hours of recovery, the child may go home. You should have a follow-up appointment with the eye surgeon 1 to 2 weeks after the surgery.

You will probably need to put drops or ointment in the child's eyes to prevent infection.

Outlook (Prognosis)

Eye muscle surgery does not fix the poor vision of a lazy (amblyopic) eye. The child may have to wear glasses or a patch.

In general, the younger a child is when the operation is performed, the better the result. Your child's eye should look normal a few weeks after the surgery.

References

Biglan AW. Surgical Approach to the Rectus Muscles. In:Tasman W, Jaeger EA, eds. Duane’s Ophthalmology. 2012 ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2012:vol 6, chap 83.

Lingua RW, Diamond LG. Techniques of strabismus surgery. In:Yanoff M, Duker JS, Augsburger JJ, et al., eds. Ophthalmology. 3rd ed. St.Louis, Mo: Mosby Elsevier; 2008:chap 11.14.

Olitsky SE, Hug D, Plummer LS, Stass-Isern M. Disorders of eye movement and alignment. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF,eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 615.

Updated: 9/18/2012

Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Franklin W. Lusby, MD, Ophthalmologist, Lusby Vision Institute, La Jolla, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.


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