1. Eye
muscle surgery involves making an incision on the outer cellophane like
covering of the eye, the conjunctiva, and isolating one or more of the
eye muscles that move the eyes in various directions.
2. No incision
is made on the skin. The eye is not pulled out of the socket. The eye
is gently moved no more than one normally moves the eye when looking
around. The incision is almost always made on the eye underneath the
eyelid so the incision itself is usually not visible unless one rolls
the eyelid back.
3. The
surgery usually takes 20-40 minutes. General anesthesia is used. There
is always a very slight risk (of death or some other serious complication),
but the risk is very small, about 1 in 20,000 cases.
4. It is
important that the person undergoing surgery does not eat or drink anything
after midnight the day prior to the surgery. Nothing by mouth either
solids or liquids the morning of the surgery. Sometimes infants under
age 1 year can drink milk or liquids until 4-6 hours before the surgery.
5. The
success of the surgery is dependent on the ability of the eyes to work
together as a team, or the ability of the patient to FUSE or combine
the image from each eye successfully into a single image. On average,
one eye muscle operation has about an 80% success rate. Another operation
may be needed a few weeks, a few months or a few years following the
initial surgery.
6. If the
patient has an eye muscle problem that is intermittent rather than constant,
the chances of success are usually better than if the eyes deviate constantly.
If extremely poor vision is present in one or both eyes, the chance
of one operation being successful is generally somewhat lower.
7. The
surgery is almost always performed as DAY SURGERY: that is, the patient
comes into the hospital or day surgery facility the morning of the surgery
and goes home the same day. Almost all patients can leave the hospital
the same day the surgery is performed.
8. The
risk of losing vision from the surgery is extremely small, about 1 in
20,000 or less. If the patient wears glasses, there may be a small change
in the prescription following surgery. It is usually best to wait 6
weeks following surgery to change the prescription in the glasses.
9. What
about glasses? If you or your child wears glasses prior to eye muscle
surgery, glasses will probably (not always) be needed after surgery.
If you or your child does not wear glasses prior to surgery, glasses
may be needed after surgery to help keep the eyes working together.
If prisms are worn in the glasses, then a pair of glasses without prisms
should be obtained prior to surgery to be used immediately following
surgery.
10. The
amount of pain following surgery is variable. Some very young patients
wake up with very little pain. Generally, a child will have some soreness
in the eyes for 1-3 hours, during which time a cool rag on the eyes
is helpful. All patients over age 2 years will receive one medication
to prevent pain and one medication to prevent nausea in the IV during
surgery. Usually these medications prevent much of the pain and nausea
that once followed eye muscle surgery.
11. After
1-3 hours, the eyes are usually not extremely sore. There may be a foreign
body sensation, like having an eyelash in the eye that may persist for
2-4 days.
12. The
eyes normally stay red for 1-2 weeks or sometimes more following eye
muscle surgery. If the redness in the eyes increases markedly, or if
the eyelids become red and swollen, an infection on the outer surface
of the eye may be present. Antibiotics by mouth may be required. The
patient is usually given a prescription for antibiotics by mouth to
be used only if the redness and swelling in the eye or the eyelids increases
markedly. You should call our office if the redness and swelling of the
eye or eyelids increases to find out whether you should begin the
antibiotic.
13. If
you live within 30-45 minutes of the office, you will usually be asked
to come to the office in the first 3-4 days following surgery. If you
live more than 45 minutes from the office, you will usually be asked
to call us on the Monday following the surgery to see how the eyes are
recovering. Following this first postoperative contact, you will usually
be seen about 6 weeks following the surgery.
14. Usually
a change in the position of the eyes will be noted soon after surgery,
but the final effect cannot be completely assessed for four to six weeks
after the surgery.
15. If
the patient is taking any medications regularly, you should ask whether
these medications should be taken the morning of the surgery. Most medications
are not given until after the surgery but essential medications (for
example, for seizures or high blood pressure) can be taken the morning
of surgery with a small sip of water.
16. You
will have an opportunity to talk with a member of the anesthesia team,
usually one of the anesthesiologists, the morning of the surgery. Patients
under age eight or nine years of age are usually "put to sleep"
while breathing through a mask. After the patient is "asleep"
from the anesthesia, an IV is started to give fluids and medications.
In patients over nine years, usually an IV is begun before the patient
is asleep and the patient is "put to sleep" with medication
given through the IV. If the patient is under age 1 year, sometimes
several "sticks" are needed before an IV is successfully started.
The IV "sticks" will leave a small mark in the skin that usually
heals completely in a few days.
17. Following
surgery, eye drops containing an antibiotic to prevent infection and
a steroid to decrease redness and swelling will be placed in the eye.
This eye drop will be continued following surgery as long as there is
any mucus or yellow drainage from the eye. If there is no mucus or yellow
drainage from the eye, the eye drop should not be given. The eye drop
should not be used simply because the eyes are red; the eye drop should
only be continued if a mucus or yellow drainage continue to come out
the eye.
18. Eye
muscle surgery has become a highly skilled procedure that is often successful
in restoring binocular vision. This surgery has only been used widely
across the United States over the last 50-60 years and is still only
rarely done in many parts of the world. We are very fortunate to live
in a country that has been the pioneer of this type of surgery that
has been extremely beneficial in improving the eyesight of thousands
of people who in years past had no way to regain binocular vision.
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