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Strabismus Surgery

Last updated May 6, 2019

Approved by: Maulik P. Purohit MD, MPH

Strabismus Surgery (or Squint Repair) is a surgical procedure that improves abnormal tension of the muscles within the eyes that are involved in the movement of the eyeballs.

Background Information:

What are the other Names for the Procedure?

  • Extraocular Muscle Surgery for Squint
  • Repair of Cross-Eye
  • Squint Repair

What is the Strabismus Surgery surgical procedure?

Strabismus Surgery (or Squint Repair) is a surgical procedure that improves abnormal tension of the muscles within the eyes that are involved in the movement of the eyeballs.

What part of the Body does the Procedure involve?

Strabismus Surgery involves the eyes. Either one eye or both the eyes may be affected, though usually both the eyes are affected.

Why is the Strabismus Surgery surgical procedure Performed?

A Strabismus Surgery is performed for the following reasons:

  • To realign the eyes to a normal balanced position, which helps improve the vision
  • To improve visual appearance of the eyes

What are some Alternative Choices for the Procedure?

Currently, there are no alternatives to Strabismus Surgery (or Eye Muscle Repair for Squint).

What are the Recent Advances in the Procedure?

There are no recent advances to the Strabismus surgical procedure.

What is the Cost of performing the Strabismus Surgery surgical procedure?

The cost of Strabismus Surgery depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused by the information regarding Strabismus Surgery and on what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
  • Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006

http://www.nlm.nih.gov/medlineplus/ency/article/002961.htm (accessed on 05/12/2015)

Prior to Strabismus Surgery surgical procedure:

How is the Strabismus Surgery surgical procedure Performed?

The Strabismus Surgery procedure may be performed under general anesthesia (in children) or local anesthesia (in adults).

  • After keeping the eyelids open, the ophthalmic surgeon makes an incision on the conjunctiva (the transparent tissue that covers the white of the eye)
  • The muscles that control eye movement are then identified
  • These muscles are then either strengthened (by removing a portion of the muscle or the tendon to make it shorter) or weakened (by cutting the muscle at its attachment and then reattaching it further back on the eye ball) in order to bring the eyeball into proper alignment
  • The procedure may be repeated on the other eye, if necessary

Where is the Procedure Performed?

Strabismus Surgery is usually performed in an out-patient surgery center facility or a hospital.

Who Performs the Procedure?

An ophthalmologist performs the Strabismus surgical procedure.

How long will the Procedure take?

The surgical procedure may take an hour or so to perform.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Strabismus Surgery and helps avoid unnecessary complications.

  • Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
  • If you are allergic to any specific medication or food items
  • If you are taking blood thinners such as aspirin, warfarin, herbal supplements, or any other such medications
  • If you or your family members have a history of bleeding disorders or if there is a tendency to bleed more than normal
  • If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
  • If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
  • If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
  • A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
  • Some medications increase a person’s chances of bleeding, and it may be recommended to discontinue them for a period of time before the procedure is performed
  • Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
  • Do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
  • Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
  • It is advisable to quit smoking and the use of any nicotine based products for a while before the surgery
  • Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
  • The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
  • For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Strabismus Surgery procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Strabismus Surgery surgical procedure?

Before the Strabismus Surgery, a special eye examination to verify the total amount of deviation is required.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

  • What is a Strabismus Surgery?
  • Why is this procedure necessary?  How will it help?
  • How soon should I get it done? Is it an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed? 
  • What are the risks while performing the procedure?
  • What are the complications that might take place during recovery?
  • How long will it take to recover? When can I resume normal work?
  • How many such procedures have you (the physician) performed?
  • Are there any follow-up tests or periodic visits to the healthcare facility required after the procedure?
  • What are the costs involved?

During the Strabismus Surgery surgical procedure:

What kind of Anesthesia is given, during the Procedure?

General anesthesia by injection and inhalation (for children) or local anesthesia by injection (for adults) is administered prior to Strabismus Surgery.

How much Blood will you lose, during the Procedure?

There is no blood loss involved during the Strabismus surgical procedure.

What are the possible Risks and Complications during the Strabismus Surgery surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

  • Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
  • Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk
  • Advancing age
  • Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
  • Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
  • Poorly functioning liver, as evidenced by increased blood liver function tests
  • Hypertension (increased blood pressure), especially if it is poorly controlled
  • Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
  • Poor lung function, as evidenced by abnormal lung function tests
  • History of bleeding disorders
  • Longstanding illness such as autoimmune disorders or chronic infections
  • Poor immune system due to a variety of causes

The possible risks or complications that may arise during the Strabismus Surgery are:

  • Bleeding
  • In rare cases, infection within the surgical wound
  • Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after the Strabismus Surgery surgical procedure?

At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise.

After the Strabismus Surgery surgical procedure:

What are the possible Risks and Complications after the Strabismus Surgery surgical procedure?

The possible risks and complications that may arise after a Strabismus Surgery are:

  • Bleeding
  • In rare cases, infection within the surgical wound
  • Swelling within the eyelid
  • The need for additional surgical procedure, if further correction is required

What is the Prognosis after the Surgery?

A complete recovery from a Strabismus Surgery is usually achieved without any serious complications being observed.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

  • Pain that worsens and swelling around the surgical wound
  • Bleeding or fluid drainage from the surgical wound
  • Signs of an infection
  • Muscle aches, headache
  • Dizziness
  • Fever, feeling sick
  • Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Strabismus Surgery surgical procedure?

At home, the following post-operative care is recommended, after a Strabismus Surgery:

  • Slowly resume regular/daily activities at least a week after surgery
  • Keep the eye dry (per instructions of your physician)
  • Use anti-inflammatory and moisturizing eye drops (that are prescribed)
  • Complete the course of prescribed medication under advice of the physician
  • Take antibiotic medication to help combat or prevent infection (per the physician’s advice)
  • Avoid taking nonprescription medications such as aspirin. However, individuals may take acetaminophen to relieve pain, per the physician’s advise

How long does it normally take to fully recover, from the Procedure?

It usually takes about a few days to fully recover from the Strabismus Surgery.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The procedure does not involve the surgical removal of any tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Strabismus Surgery surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The outpatient facility or a hospital
  • An anesthesiologist (if anesthesia was administered)
  • An ophthalmologist

The patient is advised to inquire and confirm the type of billing, before the Strabismus Surgery is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: May 27, 2015
Last updated: May 6, 2019