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Squint correction surgery


Expert reviewer, Professor Simon Taylor, Consultant Ophthalmic Surgeon
Next review due September 2020

Surgical correction for a squint is an operation to straighten your child’s eyes so they no longer look in different directions when focussing on something. That is called a squint; its medical name is strabismus.

You can find out more about the types and causes of squint and other, non-surgical treatments from our topic on squint.

Squint is most common in children, so we’ll focus here mainly on squint surgery in childhood. However, adults can also have squint surgery. If you’re having squint surgery as an adult, a lot of this will still apply to you. But ask your surgeon for details of what will happen in your particular circumstances.

An image of a child with a convergent squint

About surgical correction for squint

Squint correction surgery is done by an ophthalmologist, a surgeon who specialises in eye health. They surgically adjust the various muscles that control eye movement. This straightens your child’s eyes so that they both look in the same direction. This helps your child develop better binocular vision, which allows them to judge distances and see in three dimensions.

Surgery can be done on one or both eyes. In about one in three people the operation needs to be repeated to straighten the eyes successfully.

Your child’s ophthalmologist will discuss with you whether surgery is the best option for your child. They’ll also recommend the best time to carry out the surgery. This may vary depending on the type of squint your child has and its cause. For instance, if your child is born with a squint they may have the operation between the age of about six months and two years.

If your child has a lazy eye (amblyopia) or an eyesight problem, such as long-sightedness, they’ll usually be treated with glasses and patching before surgery. (See our topic on squint for more information about lazy eye, and other treatments for squint). This is because treating these beforehand may improve your child’s binocular vision after their operation.

Adult patients may have squint surgery, either because they didn’t have it done as a child or because the squint happened as an adult.

What are the alternatives to surgical correction for squint?

Squint surgery is usually offered after other treatments for squint have already been tried. See our topic on squint for more information about non-surgical treatments.

For some children, wearing prescription glasses will encourage their eyes to straighten. Glasses will help if a squint has developed because of an eyesight problem, most often long-sightedness. In adults, glasses can be made up with a prism (a special type of lens) to help reduce double vision.

Depending on the type of squint, your child may be taught special eye exercises by an orthoptist. An orthoptist is a healthcare professional who specialises in eye movement problems, such as squints, lazy eyes and double vision.

In some cases, squint may be treated with Botox (botulinum toxin) injections. This can be injected into the eye muscles to weaken a muscle that’s pulling the eye in the wrong direction. The treatment lasts a few months and then needs to be repeated.

All treatments have pros and cons. Ask the ophthalmologist to explain the options for treatment in your child’s individual circumstances.

Preparing for surgical correction of squint

Your hospital will give you information about how to prepare your child for their operation, and what will happen on the day of their surgery.

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.

Your child will have a general anaesthetic, so will be asleep during the procedure. This usually means they mustn’t eat or drink for about six hours before the general anaesthetic. But follow any advice your surgeon or the hospital gives you.

Before the operation, a nurse will ask you about your child’s general health and measure their heart rate and blood pressure. Make sure you tell the nurse if your child is allergic to anything.

Your child’s ophthalmologist will discuss with you what will happen before, during and after the procedure, and any discomfort your child might have. This is your chance to ask questions so that you understand what will be happening. You don’t have to let the procedure go ahead if you decide you don’t want it to. Once you understand the procedure, and if you agree that your child should have it, the surgeon will ask you to sign a consent form. If your child is old enough, they may wish to sign the consent form too.

What happens during surgical correction of squint?

Your child will be asleep during their squint correction procedure.

The surgeon makes small cuts in the thin outer semi-transparent coat of the eye (the conjunctiva) to reach the muscles that move the eye.

The exact details of the operation can vary, but two techniques are 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 operate on the muscles in both eyes or just one eye, depending on the squint. Sometimes the muscles on both eyes need to be adjusted to help the eyes work together as a pair, even if just one eye turns.

Adults and some teenagers who have squint correction surgery may have adjustable stitches put in. These allow the surgeon to fine tune the position of your eye muscles after you wake up from surgery. See our FAQ below for more information about adjustable stitch surgery.

What to expect afterwards

Nurses will monitor your child in the theatre recovery area for a short while after the operation. They’ll probably call you so that you’re there when your child wakes up. Children usually recover quickly after their surgery and will probably be able to open their eyes right away.

Your child may be groggy, and feel sick or vomit. Many young children seem distressed when they wake. The nurses have a lot of experience caring for children after an anaesthetic, so they’ll support you in reassuring your child. Your child will need to rest in bed or on your lap until the effects of the general anaesthetic have passed.

Usually, your child will be able to go home without a patch or dressing covering their eye(s). Their eyes will be red.

A nurse will give you advice about caring for your child’s eyes before you go home. They’ll probably give you 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 them over-the-counter painkillers such as paracetamol or ibuprofen syrup. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice. Don’t give aspirin to children under 16.

Your surgeon or nurse will probably give you advice about how best to help your child recover. Most children stay off school or nursery for a week after squint correction surgery. You can wash their hair, but try not to get soap or shampoo in their eyes for at least the first week. They shouldn’t play with sand (which might get in their eyes) or do any strenuous exercise for two weeks. And they should avoid swimming for four weeks. It’s important to follow any advice the surgeon gives you.

Children tend to recover quickly following surgery. Any redness or watering of the eyes doesn’t usually cause any pain or discomfort for more than a day or two. Your child’s eye(s) may look quite bloodshot for a while. However, this usually goes away within a couple of months.

Contact your GP or the hospital if:

  • your child complains of severe pain or shows signs that pain is getting worse
  • you notice a sticky discharge coming from your child’s eye(s), as it may be a sign of infection

You should be aware that, if your child wore glasses before their squint surgery they’ll probably have to keep wearing them afterwards.

Side-effects

Side-effects are the unwanted, mostly temporary effects your child 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 their eye(s) after the operation. However, the soreness will improve after a few days and the redness within a few weeks or months.

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.

The most common complications of squint correction surgery are:

  • over-correction or under-correction of your child’s squint. They may need further surgery to fully correct the squint.
  • your child’s squint coming back.

Other, much less common complications include the following.

  • Some double vision after the operation.
  • Infection of the eye, requiring antibiotics.
  • A slipped or lost eye muscle, when a muscle drops back behind the eyeball either during surgery or afterwards. Your child may need further surgery to correct this.
  • An accidental cut making a small hole in the outer coat of the eye (the sclera). It can lead to serious infection inside the eye for which your child may need antibiotics.
  • Loss of vision – any operation on the surface of the eye carries a slight risk of this.

If you want to know more about the possible risks and complications of squint correction surgery, ask your child’s ophthalmologist.

Frequently asked questions

  • Surgical correction for squint is usually carried out when your child is young. This is to try to protect as much binocular vision as possible. (Binocular vision is when the eyes work together to allow your child to see in three dimensions and judge distances). If you delay the operation, their long term binocular vision probably won’t be as good.

    Your child’s ophthalmologist will carefully assess the best time for your child to have their surgery. This may depend on the type of squint they have.

    Some babies develop a squint under the age of six months. This is called infantile or congenital squint. Operations to correct infantile squint are usually done when a child is between the ages of about six months and two years.

    If your child develops a squint when they’re older, the timing of surgery may depend on how well other treatments (such as glasses) work.

    If surgery is recommended, having it when they’re young gives the best possible chance of your child developing good binocular vision. This is because binocular vision develops during early childhood. If the eyes don’t face in the same direction together during this time, binocular vision can’t develop properly. So if your child’s squint isn’t treated early, their binocular vision may never develop fully.

    If you’re concerned about the timing of your child’s squint correction surgery, talk to their ophthalmologist. They can explain what’s likely to be best in your child’s individual circumstances.

  • Adjustable stitch surgery for squint involves using special movable stitches. These let the surgeon fine tune the position of the eye muscles after the operation. This technique is usually only used with adults.

    Adjustable stitch (suture) surgery is a way of correcting a squint that allows the positions of the eye muscles to be altered after the operation. It’s useful for fine-tuning squint correction.

    Your ophthalmologist will operate on your eye to both weaken and strengthen the eye muscles. See our section on what happens during surgery above for more information about how this is done.

    During your surgery, your eye muscles will be fixed into place using one or more special stitches, which have movable knots. After the operation, while you’re awake, your ophthalmologist will tighten or loosen the knot(s) so that your eye is straight. This is usually the same day or the day after your operation. You’ll be given anaesthetic eye drops to numb your eye.

    This technique isn’t generally used with young children because it’s hard for them to keep still and co-operate when the knot is being adjusted. Some teenagers, however, may be able to have adjustable stitch surgery.

  • No. Surgical correction for a squint is used to straighten your child’s eye so that both eyes look in the same direction. If your child has developed a lazy eye (amblyopia) because of their squint, surgery alone won’t correct it. Your child will need other treatments, such as eye patching, which force the eye to work. See our topic on squint for more information about treatment for a lazy eye.


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Related information

    • Strabismus. BMJ Best Practice. bestpractice.bmj.com, last updated 1 April 2016
    • Infantile esotropia. Medscape. emedicine.medscape.com, updated 9 February 2017
    • Strabismus (squint). PatientPlus. patient.info/patientplus, last checked 25 June 2015
    • Strabismus. The MSD Manuals. www.msdmanuals.com, last full review/revision May 2016
    • Squint in children. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised March 2016
    • Map of Medicine. Squint and amblyopia in children. International View. London: Map of Medicine; 2017 (Issue 3)
    • Guidelines for the management of strabismus in childhood. The Royal College of Ophthalmologists, 2012. www.rcophth.ac.uk
    • Childhood squint (strabismus). Royal National Institute of Blind People. www.rnib.org.uk, accessed 1 September, 2017
    • Adult strabismus. American Association for Pediatric Ophthalmology and Strabismus. aapos.org, updated November 2016
    • Strabismus surgery. American Association for Pediatric Ophthalmology and Strabismus. aapos.org, published November 2014
    • Adjustable sutures. American Association for Pediatric Ophthalmology and Strabismus. aapos.org, published November 2014
    • Your child’s general anaesthetic. Royal College of Anaesthetists, 2014. www.rcoa.ac.uk
    • Personal communication, Professor Simon Taylor, Consultant Ophthalmic Surgeon, September 2017
  • Reviewed by Dr Kristina Routh, Freelance Health Editor, Bupa Health Content Team, September 2017
    Expert reviewer, Professor Simon Taylor, Consultant Ophthalmic Surgeon
    Next review due September 2020



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