Strabismus / Lazy Eye
Adult patients with strabismus have eyes that are misaligned so that when one eye focuses on an object, the other may turn in, out, up, or down. Sometimes adult patients with strabismus had it corrected as a child and it returns when the patient is older. Other times the strabismus slowly gets worse over time, or it may be the consequence of previous head injury, disease, or poor vision in one eye. Adult onset or acquired strabismus often produces double vision.
Fortunately, strabismus can be treated with surgery and double vision can be helped with prism glasses. Surgery can adjust the muscles that hold the eye in place, ensuring that these muscles can contract or lengthen when the patient looks at a close or far object. You can see two power point presentations of how the surgery is performed. See loosening procedure (“Recession”) and tightening procedure (“Resection”) presentations below. Strabismus is best treated when the patient is a child but it can be improved at almost any age.
We like to share a story of an adult attorney who visited our office because she was cross eyed. She had been cross eyed and teased her whole life. When she was a child her parents had been told that the strabismus could be fixed and that it might come back. Unfortunately they thought “what is the point?” and left it untreated. We explained that yes, sometimes it does come back, and we simply fix it again. We were happy to offer her strabismus surgery. Her condition was improved with one procedure and after 29 years of being cross eyed she was able to have straight eyes.
This condition is not considered cosmetic and is covered by health insurance companies in the same way liver or knee surgery would be covered. Treating adults with strabismus can improve depth perception, fusion and the field of vision. Many patients report enhanced self-esteem, communication skills, job opportunities, reading and driving.
Even though the patient’s left eye was not crossing, this patient required surgery on two muscles of her right eye and one muscle of her left eye.
Without operating on the left eye muscle there would have been some residual eye crossing after the surgery.
Decades of scientific research have produced surgical tables and graphs which let your eye surgeon know how much to move each operated muscle, and how many muscles to operate depending on the amount of eye deviation present.
“My right eye was permanently turned in. I was having constant double vision and headaches. I was referred to Dr. Vicente at Eye Doctors of Washington for evaluation of my strabismus. He took the time to explain my problem. After a couple of office visits he had sufficient eye measurements to offer me eye muscle surgery to align my eyes. The surgery went well and after a few weeks, my eyes had healed and my double vision and headaches resolved. I am thankful to Dr. Vicente and his staff. ”
My parents have noticed my strabismus when I was four years old. In the beginning it was just one eye, but later in my twenties I have developed it on the second eye as well. I also started getting headaches and occasionally double vision.
I originally visited Dr. O’Neill and Dr. Vicente’s office with my baby son – his pediatrician recommended that I check him for signs of strabismus. I myself got so used to living with it that I was not even considering operation before that visit. I was also told by someone several years ago that adjusting it at my age might interfere with some brain functions (now that does not seem as a very professional opinion).
During my son’s check-up Dr. Vicente mentioned that not only is it possible for grown-ups, but that it is a routine operation performed by him on a regular basis and everyone’s brain remained fine so far .
So after two more office visits and many of my questions answered in great details I went for the operation and do not regret it a bit. The procedure was very straight forward. I checked-in at the hospital early in the morning and was ready to go home around the afternoon. There was no pain whatsoever during the operation itself, as it was done under anesthesia. After the surgery I felt very nauseous, which is normal and I consumed quite a number of popsicles in the next 24 hours. My eyes were bloodshot for first 10 days after the surgery, so I was wearing dark glasses. My eyes hurt first couple of days after surgery but it was not a severe pain. I spent first 24 hours after the operation in bed with ice bag over my eyes.
Now, several months later all this seems just like a minor discomfort in comparison to getting my eyes straight. Not to mention physical discomfort, those who have strabismus know how embarrassing it can be sometimes when strangers either do not look you in the eyes or trying to figure out what are you looking at.
So to everyone who is considering strabismus surgery I highly recommend Dr. Vicente. He is a confident professional you can entrust yourself and I am very grateful to him.”
Botox Injection Example
Strabismus means that the eyes are not straight. There many different types of strabismus, such as “crossed eyes” (esotropia), “wall-eyes” (exotropia), or “one eye higher than the other” (hypertropia). These occur when eye muscles are too strong or weak. There are 6 muscles that move each eye, so there are many combination’s of weak or strong muscles that stop the eyes from being straight. Surgery involves tightening weak eye muscles and loosening stronger muscles to balance their powers so that the eyes will point in the same direction and move together. Stitches (sutures) are used to secure the muscles in position onto the surface of the white coat of the eye (sclera). Lasers are not used in this surgery and the eye is never removed from its socket.
Surgery is performed if all other treatments have failed to straighten the eyes. These treatments can include glasses, prisms, eye exercises, or medications. In some children patching is used to improve the vision in a “lazy eye” or to stop an eye turn from getting worse before surgery is done.
Surgery can be done using a general anesthetic (patient is completely asleep) or using a local anesthetic around the eye along with sedation. In adults, some surgery can be done using an “adjustable” (or “movable”) suture, the alignment can be adjusted after the patient wakes up from anesthesia
Eye muscle surgery is almost always done as an out-patient procedure. In rare cases a patient has to be admitted to hospital on the day of surgery to be observed overnight.
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.
Follow up appointments after surgery are scheduled within the first week and 4-6 weeks and 4-6 months. The assessments at these appointments are as important as the surgery itself in leading to a successful result. After surgery the eyes are red and slightly swollen over the muscles that were moved for up to 6 weeks. The stitches dissolve on their own over 6 weeks.
Some patients have double vision (“seeing two of everything”) right after eye muscle surgery because they are not used to the change in the position of their eyes. Double vision goes away in over 90% of cases within the first 4 to 6 weeks after surgery as the patient gets used to the new direction of the eyes. Other risks from the surgery include:
- infections on the surface of the eye (risk 1 in 500) or inflammation from the stitches on the surface of the eye (risk 1 in 100)
- infection in the eye socket (risk 1 in 500), damage to the eyeball from suture needles or the suture tracks (risk less than 1 in 1000), or infections within the eyeball (risk 1 in 30,000), and any of these three problems can lead to loss of vision in the eye
- risks associated with general or local anesthetics, which are uncommon (risk 1 in 300,000)
Overall, eye muscle surgery leads to straight eyes 80% of the time. In other words, 1 in 5 patients needs further treatment or more surgery to straighten the eyes.