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Surgical correction of childhood squint

Published by Bupa's Health Information Team, August 2011.

This factsheet is for parents of children who are having surgery to correct a squint, or who would like information about it.

A squint is a condition that causes one eye to look in a different direction to the other when focusing on an object. It’s also called a strabismus. Surgical correction for a squint is used to straighten a child's eye so that both eyes look in the same direction.

You will meet the surgeon carrying out your child’s procedure to discuss his or her care. It may differ from what is described here as it will be designed to meet your child’s individual needs. 

About surgical correction for squint

An ophthalmologist, a doctor who specialises in eye health, including eye surgery, will carry out the operation. He or she will use a combination of surgical techniques to both weaken and strengthen the muscles that control eye movement. This will straighten the eye that has the squint so that both eyes look in the same direction.

The age at which your child has the operation will vary depending on how much the squint is affecting his or her sight. Any problems or conditions that affect the eyes during childhood can have a great impact on the part of the brain involved in the development of vision.

With a squint, the main aim of surgery is to improve your child's vision by bringing the eyes into alignment. This will allow your child to develop binocular single vision (the ability to perceive a single image, even though each eye picks up slightly different images), which can be affected by having an untreated squint. Depending on your child's sight, he or she may have better depth perception (the ability to determine the distance between objects) following surgery.

It's important that if your child already has a lazy eye (amblyopia) or a refractive error (such as long- or short-sightedness), this is treated before surgery is carried out. This is because the eye with a squint is more likely to stay straight if the vision in it is good beforehand.

Surgery is usually carried out between the age of six months and two years if your child is born with a squint. If your child develops a squint when he or she is older, depending on the cause, surgery will be done as early as possible after diagnosis. However, the decision to operate should be made after discussions with your child's ophthalmologist.

If your child has a squint as a result of a neurological disorder, such as cerebral palsy, it's best to wait until he or she is over the age of two before having surgery. This is because these types of squint can change in angle and direction during infancy.

What are the alternatives to surgical correction for squint?

An orthoptist (an healthcare professional who specialises in eye movement problems, such as squints, lazy eyes and double vision) can teach your child exercises to treat his or her squint and any associated amblyopia (lazy eye).

For some children, wearing prescription glasses may encourage their eyes to straighten. Glasses will also help if your child's sight is poor because of refractive errors. They may also help if he or she has a lazy eye so that vision from this eye may improve. In adults, glasses can be made up with a prism (a special type of lens) to compensate for any double vision.

Botulinum toxin A (eg Botox) can be injected in very small amounts into the eye muscles to paralyse them. This can be used to weaken a muscle that is pulling the eye in the wrong direction. The treatment is temporary (lasting only a few months before another treatment is needed) and can be used on children under a year old. However, this is a relatively new treatment that has little evidence for its effectiveness and is not yet widely available.

Preparing for surgical correction of squint

Your surgeon will explain how to prepare your child for his or her operation.

Surgical correction for a squint is usually carried out as a day case. This means that your child will be able to go home the same day.

The operation is carried out under general anaesthesia. This means your child will be asleep during the procedure. Typically, your child must not eat or drink for about six hours before a general anaesthetic. Often the operation is planned for the morning, so that your child will only have to miss breakfast.

Before his or her operation, a nurse will ask you about your child's general health. The nurse will also check that your child has not had anything to eat or drink and measure his or her heart rate and blood pressure. You must tell the nurse if your child has had any allergic or unusual reactions to medicines in the past, or if there is any history of bleeding problems in the family.

Your child’s ophthalmologist will discuss with you what will happen before, during and after your child’s procedure, and any pain he or she might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form. If your child is old enough, he or she may wish to sign this form too.

What happens during surgical correction of squint?

The operation will take approximately one hour. The surgery that your child has will vary depending on the type of squint he or she has and the ophthalmologist's chosen technique.

The muscles around the eye are accessed through small cuts in the thin outer semi-transparent coat of the eye (the conjunctiva). The cuts are made just a few millimetres back from the cornea (the clear window at the front of the eye).

There are two techniques that are most commonly used.

  • Muscle recession involves detaching the muscle from the eye and moving it further back so that it becomes weakened.
  • Muscle resection is when a section of the muscle is removed to tighten and strengthen it

Your surgeon may choose to operate on the muscles in both eyes depending on the nature of the squint.

What to expect afterwards

Usually dissolvable stitches are used during the operation. Dissolvable stitches don't need to be removed. The length of time your dissolvable stitches will take to disappear depends on what type you have. However, for this procedure, they should usually disappear in a month or two.

Your child will be monitored for a short while after the operation. He or she may be groggy, and feel sick or vomit. Your child will need to rest in bed or on your lap until the effects of the general anaesthetic have passed.

A clear shield may be placed over your child’s eye after surgery, but no dressings will be needed. Usually, your child will be able to return home without anything covering his or her eye(s).

A nurse will give you advice about caring for your child's eyes before you go home. Typically you will be advised not to take your child swimming for about three weeks. You will usually be given eye drops for your child and a date for a follow-up appointment.

Recovering from surgical correction of squint

Your child may feel some discomfort for a few days after the operation. If needed, you can give him or her over-the-counter painkillers such as paracetamol or ibuprofen syrup (for example, Calpol). Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice. Do not give aspirin to children under 16.

Children tend to recover very quickly following surgery and any redness or watering of the eyes doesn't usually cause any pain or discomfort for more than a day or two.

Contact your GP or the hospital if your child complains of severe pain or shows signs that pain is getting worse. Babies and toddlers cry more and are difficult to settle when they are in pain.

The appearance of the eye(s) may be quite bloodshot at first. This is caused by small amounts of blood under the translucent outer coat of the eye. However, this usually goes away within a couple of months.

Infection is rare following squint surgery. However, if you notice a sticky discharge coming from your child's eye, contact your GP.

What are the risks?

As with every procedure, there are some risks associated with surgical correction of squint. We have not included the chance of these happening as they are specific to your child and differ for every person. Ask your child’s ophthalmologist to explain how these risks apply to your child.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after the procedure, for example, feeling sick as a result of the general anaesthetic.

Your child may have discomfort, watering and redness of his or her eye(s) after the operation. However, he or she will probably find these symptoms get better within a week or two.

You may notice that your child's eye does not look as 'white' as it did prior to surgery. This is a part of the healing process and is usually unavoidable and untreatable, but it may become less apparent over time. Your child will be prescribed eye drops for use after surgery to help the healing process.

Complications 

Complications are when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, infection, or excessive bleeding.

Complications specific to surgical correction of squint include the following.

  • Your child’s squint may come back.
  • Children can react differently to surgery so the results of the operation can't be guaranteed and further surgery is sometimes needed. It's important to discuss this with your child's ophthalmologist before the surgery takes place.
  • Your child may have a slipped or lost eye muscle. This is when a muscle drops back behind the eyeball either during surgery or afterwards if it’s not securely attached to the eye. Your child may need further surgery to correct this.
  • There could be a cut to the eye that occurs when the muscle is reattached to the thin outer coat of the eye (the sclera). It can lead to serious infection in the eye for which your child may need antibiotics. The retina can become detached as a result of the cut, but this is rare.
  • Scar tissue can form because of an overactive healing response to the stitches used to reattach the muscle to the eye. Your child may need to be treated with steroids applied to the scarring, or may need further surgery to remove the scar tissue.
  • Your child may have some double vision but this is usually more of a problem in adults because children's brains can relearn to interpret the images coming from each eye after surgery.

 

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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  • Publication date: August 2011

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