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Squint Surgery

What does squint surgery involve?

The eyeballs are moved in different directions by the eye muscles. There are 6 muscles for each eye, all controlled by the brain. Two muscles on each eye deal with horizontal movements, and two with vertical. There are two other muscles – the oblique muscles – which do a combination of different movements. The way the muscles work is a bit like the reins of a horse.

In squint surgery, one or more muscles are altered surgically to cause a change in the direction of the eye. A muscle can be moved forwards on the eyeball, moved backwards, shortened, or moved to a different point of attachment. The muscle is sticthed in its new position and after a few weeks it has firmly stuck down on the eyeball.

At no point in squint surgery is the eyeball taken out, placed on the cheek, or turned around. These are all old wives tales.

Access to the muscles is via the white membranes on the surface of the eye, so no skin on the eyelids is cut. All the surgery is done outside the eyeball so nothing enters the eyeball itself. The surgery involves dissecting and stitching. Lasers are not used for squint surgery unlike in some other forms of eye surgery.

Most operations can be done in under an hour. Most people choose a general anaesthetic for their surgery but squint surgery can often be done with a local anaesthetic as well, using an injection or drops. If you opt for a local anaesthetic you will be offered a sedative to make you feel relaxed and calm throughout.

The skill of squint surgery lies in knowing what operation to do for what problem, and how much to do. It is an art and a science. The success of your surgery heavily depends on the skill of the surgeon doing your operation. Even the healing time and how the eye feels afterwards are often due to the attention to detail of the surgeon at each stage of the surgery.

 

What are the risks of squint surgery?

Squint surgery is one of the safest types of eye surgery. This is largely because it doesn’t involve entering the eyeball at all, so the risk to the important structures inside the eye is very low.

Nevertheless, there are some risks with every type of surgery and it is important to know about these to make a fully informed decision. The precise risks which apply to your eyes are best discussed with your squint specialist but here is a general idea of the types of risks involved.

The commonest “risk” is simply that squint surgery is not accurate in 100% of cases. This means that sometimes there is an undercorrection (not enough of a correction) or an overcorrection (too much of a correction, so the eye goes the other way). The good thing about this is that this can often be remedied by further surgery if required.

Sometimes people experience double vision after squint surgery. This could be totally new double vision or just a different type of double vision from what they noticed before. Often this is just a sign that the brain has noticed that the eye position has changed and is learning how to deal with the new images it receives from the eyes. Most people don’t get any double vision but if it happens, it usually settles in a few weeks. Rarely it can be permanent and can require further treatment to deal with.

The thing that many people fear about eye surgery is losing their vision. Fortunately this is extremely rare in squint surgery, occurring in only 1 in 10,000 cases.

What matters to more people is the healing of the tissues on the surface of the eye after squint surgery. Cutting and stitching eye muscles leads to a healing response which causes redness in the white of the eye. This redness is quite marked in the first two weeks then persists but reduces gradually until about 6-7 weeks after surgery when the stitches dissolve. Then there is a slow improvement in redness over the next 1-3 months. For most people, it clears completely but in a few, a mild redness persists long-term. In a few people, their eyes have an exaggerated healing response and a small lumpy scar is formed which may require further surgery to treat, but this is quite rare.

When you discuss the risks of surgery with your squint specialist, you will normally be quoted standard risks. But is important to know that the risk that applies to you is a combination of the state of your eye tissues and the technical skill of your surgeon.

 

What is the recovery like?

Squint surgery is day surgery so you go home on the day of surgery. For the first couple of days the eye has a dull ache and you will probably need to take some simple pain killers such as paracetamol. In the first week after surgery, you will feel your eye is very irritable, gritty, watery, sticky and red. Your vision may be a bit blurry for a few days.

You may also notice that the eye looks smaller due to swelling of your eyelids. All of this is perfectly normal and is part of your healing response. Over the next 5-6 weeks, these symptoms reduce week by week until you are left with just a gritty eye with redness. The grittiness comes from the stitches that were used in the operation. They take 6 weeks or so to dissolve. You don’t need them removing – they disappear themselves. After about 6 weeks or so, the redness will continue to lessen but more slowly, often taking another month or two to fully settle. But during this period the eye feels close to normal.

There may be some settling down of the eye position in the first month or so. Some days the eye may go in, or out, and you may get double vision from time to time, or in certain directions. This is all part of the bedding down of the eye in its new position and the brain getting used to it. Your eyes will achieve the final position around 2 months following surgery.

Most people take about 1-2 weeks off from work after surgery. Some people can get back to work within a week but normally the eye is a bit too irritable and sticky to resume work. You can do almost all other activities from the day after surgery, as long as you feel up to it – such as reading, texting, watching TV, getting out of the house, going to the gym, cycling etc. Driving is normally best left for a week or two until you are happy that you are not troubled by double vision.

You will be give drops to put into your eye for about 7 weeks. There are two bottles of eye drops – one is an antibiotic (chloramphenicol) and one is a steroid drop (dexamethasone) to help the healing process. The box shows how they are usually used.

  • Chloramphenicol drop – 4x a day for 4 weeks, then stop
  • Dexamethasone drop – 4x a day for 4 weeks, then 3x a day for 3 weeks, then stop

It is important in the first few weeks after the operation that you are very careful not to rub your eye. This could break the delicate stitches and spoil the operation. You can clean your eyelids whenever the get crusty or sticky using a wad of wet kitchen roll, by closing your eyes and dabbing gently. You should not try to remove anything from the eye itself – you may accidentally pull on a stitch.

Most people find that the recovery from squint surgery is less painful than they feared but goes on on longer that they were expecting. You normally need two check-ups after surgery: one in the first couple of weeks to check on the healing, and one after a couple of months to check on the final eye position.

What are the goals of squint surgery?

The main goal of squint surgery is to make your life better – to give you confidence to live your life without a squint getting in the way. Different people are affected by squints in different ways, and so the goals of surgery are unique to each person.

Some aims of squint surgery for people with visual problems are:

  • to reduce double vision
  • to allow you to see single without tilting or turning your head to help your eyes
  • work together better
  • to make your eyes easier to control and reduce strain

Or if your squint affects your self-image, the goals may include:

  • to make you eyes appear straighter to other people and in photographs
  • to make your eyes appear more normal
  • to make you less self-conscious or embarrassed about your eyes
  • to let you look people in the eye without fear
  • to give you more confidence at work or in social interaction

It is important your squint surgeon understands what precise goal you want from your surgery so the surgery can be tailored to help achieve what you want at each stage of the surgery.

  • About Squint

    People who have squint know how much their squint can affect their lives. Unfortunately, many other people – even doctors and opticians – don’t realise how important a condition squint is.

    » Learn More

  • Squint Surgery

    The main goal of squint surgery is to give you confidence to live your life without a squint getting in the way. Different people are affected in different ways, and so the goals of surgery are unique to each person.

    » Learn More

  • About Mr Ali

    Nadeem Ali is one of just a few surgeons in the world who is 100% focused on squint surgery in adults. He is a Consultant Adult Squint Surgeon at the world famous Moorfields Eye Hospital in London.

    » Learn More

  • Why Go Self-Pay?

    You may have medical insurance and use it frequently. Or you may never have used private healthcare before. It is important to know that there are three levels of health care in the UK including private self-pay.

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