Eye Muscle Surgery

Pre-Operative Evaluation

You will need a note from your/your child’s medical doctor before admission to the hospital. Please bring this with you.

Laboratory work may or may not be needed. This will be done if necessary the day before or the morning of surgery.

Sometime in the afternoon on the day prior to surgery you will be contacted by the hospital. The time of the last feeding prior to surgery will be reviewed. This will depend on the age of the patient and the time of the surgery. The importance of an empty stomach prior to anesthesia will be emphasized. All food and fluid will need to be held after a certain hour.

Surgery

Eye muscle surgery is designed to put the eyes in a more satisfactory alignment. Eye muscles are attached outside the eye. Each muscle has partner-muscles and opponent-muscles. The eyes move when one set of muscles pull and the opposing set relaxes. “Strengthening” operations make an individual muscle pull more effectively by shortening or tucking the muscle to reduce its effective length. “Weakening” operations make an individual muscle pull less effectively by moving the two ends of the muscle closer together.

We decide before surgery which muscles we think will be operated. However, this may be modified at the time of surgery depending on the manner in which the eyes may be moved passively under anesthesia. Then, the final decision as to the most desirable approach to the eye muscle problem is made. The operative permission therefore will always involve permission to test and operate both eyes if necessary.

Technique of surgery

The eye muscles lie beneath the filmy membrane (conjunctiva) covering the white of the eyes. Incisions are made in this filmy membrane to expose the attachment of a muscle or its tendon to the white part of the eye. These tendons are then moved in a way to make the muscle effectively longer or shorter. The muscles are reattached to the white part of the eye (sclera) by stitches. These stitches are usually absorbable material not requiring removal. Following surgery the area of the incision in the filmy membrane and the point where the sutures are placed, may exhibit some redness and swelling. The eyelids are usually not manipulated, but occasionally following surgery the eyelids maybe are temporarily discolored or swollen. Tears are usually tinged with blood the first day; tears and secretions tend to dry and collect on the eyelids.

Results of eye muscle surgery

Eye muscle surgery is not an exact science. It is based upon average responses to “shortening” or “lengthening” a given muscle a set number of millimeters. The average response to shortening or lengthening an eye muscle is predictable. However, there may be an over-response or under-response to any given surgery.

In most instances we plan to achieve with one procedure a satisfactory correction of the eye muscle problem. Because of varying responses, or because of the magnitude or complicated nature of any given muscle problem, more than one operation may be necessary. It is important not to evaluate the outcome of the surgery during the first several weeks following surgery. The operated muscles do not function with full power immediately. Until full function is regained, the eye position may change frequently. It may take up to six to twelve weeks to regain full function.

Recovery room

Following muscle surgery the patient is taken to the recovery room where special nurses and equipment are available. Here the recovery from anesthesia is supervised. When a satisfactory state of consciousness returns, the patient is sent to a separate room. The family can rejoin the patient at this time.

Post-Operative Care

Eating: Until the patient is well awake nothing by mouth should be encouraged. Once awake, the patient may have ice chips or small sips of a beverage. Nausea may occur after the administration of anesthesia. Large quantities of food should be avoided in the immediate post-operative period as they can irritate the stomach. Usually the patient is able to resume a regular diet the day following surgery.

Bandages: The eyes are not covered. There may be a small amount of discharge. The discharge may be tinged with blood. Secretions can be gently wiped away with a moist tissue.

Tearing: Tearing may occur the first few days after surgery. If it is bothersome, they can be gently wiped away with a tissue or other soft material like a towel.

Pain: Generally there is little or not pain except on extreme movements of the eyes. The patient learns this and tends to move the head rather than move the eyes.

Activity: The patient is able to use the eyes the day of surgery. All patients are allowed up with supervision the same day. Infants and small children may be held in the parents’ arms. Swimming is not permitted for one week. Keep soap and water out of eyes while bathing.

Glasses: The eyes may be light sensitive following surgery. In this case, older patients will appreciate sunglasses or wide-brimmed hats. Younger patients may choose to close their eyes to avoid the light. If glasses are worn before surgery, they will probably be continued immediately after surgery. They may be modified at some time during the post-operative period.

Medications: Any regular medication that the patient is taking should be continued upon leaving the hospital. Occasionally, special additional medicines will be prescribed for you to take home. We instill an ointment into the eyes after surgery. You will be given some of this ointment to take home. A small amount of this is to be placed inside the lower eyelids nightly for the first week. On the day of discharge from the hospital this is not necessary.

Office Visits: Generally the first checkup after surgery is within the first week. Regular visits will then be scheduled at certain intervals. If there is any problem between scheduled visits please report that and additional visits will be arranged.