Questions and Answers Regarding Squint Surgery

K is a pretty girl of 14 years. She has had a turned eye since birth (i.e. her eyes are crossed). She had surgery at aged 2 years but has been left with quite a large turn.

It has distressed her for a number of years, her friends see it and it is a source of embarrassment.

At the time of assessment K had an obvious inward turning Left eye. This turn was present at all times. It was very noticeable when talking to her.

She wanted to have it straightened and asked a series of very pertinent questions regarding the possible treatment. These questions are pertinent for all patients contemplating correction of a turned eye.

Q 1.0 Is it possible to straighten my eyes ?
A 1.0 Yes.

Explanation: It is virtually always possible to improve the position of incorrectly aligned eyes with an operation.

Q 2.0 When should I have the operation?
A 2.0 Eyes can be straightened at any age.

Explanation: Provided a patient cooperates sufficiently for the angle of the turn to be measured then the eyes can be straightened. Some techniques are more suitable for adults or very cooperative younger patients.

Q 3.0 Will it improve my vision if the eye is straightened?
A 3.0 This will occur sometimes.

Explanation: Not if the turn has been present since infancy. Correction of a turn that commences later may result in stereoscopic (3D) vision being regained. There is an improvement in The visual field (side vision) after a cross eye is straightened.

Q 3.1 Does that mean the operation is just cosmetic?
A 3.1 No!

Explanation: The operation does many things-

3.1.0. An increase in the overall visual field or side vision occurs

3.1.1 It corrects a deformity- ie the crossed eye

3.1.2 It permits correct eye-to-eye contact -people can look directly at you and you can look at them without confusion

3.1.3 This permits better personal interaction

3.1.4 There is an improvement of 'Self Image'

Q 4.0 Why did I wait until now for this operation?
A 4.0 There was no definite reason to wait.

Explanation: The surgery could have been done at any age. Probably before commencing preschool would have been a good time to avoid the embarrassment and concern at school.

Q 5.0 Sometimes I hear that glasses could make the turn better, is this true?
A 5.0 This is true if you are farsighted.

Explanation: In this case the need for glasses causes you to over- focus and the eye turns in- glasses can assist only this group of patients.

Q6.0 What about using a patch?
A 6.0 A patch does not straighten the eye.

Explanation: A patch is used if the vision is damaged as result of the turn.                 (see AMBLYOPIA) While it can improve vision in young children it does not straighten the eye. Vision cannot be improved after the age of 8 or 9 years.

Q7.0 What about exercises to straighten the eye?
A 7.0 Exercises are rarely of value.

Explanation: In the past exercises were often used before surgery but we now know for certain it is only a rare type of turn that can be assisted with exercises. Usually exercises are a total waste of time resulting in a delay of correction.

Questions regarding Squint surgery

At this stage K realises that she will need an operation to straighten her eyes but she has a number of very thoughtful questions regarding this surgery. In particular she is concerned that she will require needles and that it will be very painful. She does not want to be aware of the actual surgery.

She is also frightened of the unknown and is totally unaware of what the surgery entails.

The discussion of the surgery followed this path:

Q8.0 What will be done in the operation?
A 8.0 The length and tension of the eye muscles will be adjusted.

Q 9.0 How is it done?
A 9.0 These muscles are attached only a few millimetres from the edge of the coloured part of the eye. (DIAGRAM)They are covered by the lining of the eye (like a skin). This can be lifted and the muscle is then tightened or loosened to move the eye. The eye is never 'taken out ' for the operation but operated where it normally sits.

Q 10.0 Does it hurt?
A 10.0 No.

Explanation: It is done while you are asleep with an anaesthetic or in special cases the eye is numbed with local anaesthetic.

Q 11.0 Will it be painful after the operation?
A 11.0 Most patients complain of a sore eye.

Explanation: They usually say it was not really painful. The soreness occurs principally on the first day. Most children do not appear disturbed after the first day.

Q 12.0 What other things will be noticed after the surgery
A 12.0.1The eye(s) will be very red.

This will last for 1-2 weeks- gradually fading.

A 12.0.2 Double vision can occur

Double vision is quite common for at least a few days. Sometimes it may persist for longer periods. It is not usually a problem if the turned eye has been present since childhood.

If you have further questions please click here to send an email to Denis Stark