In this section
Surgery for turned eyes aims to improve the alignment of the
eyes, that is make the eyes "look straight".
These alternatives should have been discussed and tried (if
appropriate) before undertaking squint surgery. If you feel you do
not understand the place of alternative treatment please ask.
There are risks that are related to the general anaesthesia
required and risks specific to the eye surgery.
Once your child is asleep the skin around the eyes and the
surface of the eye is cleaned with disinfectant (Betadine). The
eyelids are then held apart with a small clamp and the eye rotated
so that the muscle that is to be operated on is accessible. The
tissue (conjunctiva) over the white of the eye is then cut open
with scissors to expose the muscle and then the muscle is either
weakened or strengthened. The muscle is reattached to the eye wall
with a suture (thread). The opening in the conjunctiva may or may
not be sutured. This process is repeated for each muscle that is
Most children do not need a detailed explanation of what is
involved in an operation but need to have questions answered
honestly, for example: "Yes, your eyes will be a bit sore after the
operation." Children want to know they will not be left alone and
that you will be there when they wake up. It is a good idea to tell
your child that s/he will meet several different people during
their visit to hospital (receptionists, nurses, orderlies,
anaesthetist and surgical assistant). Being positive about the
visit to hospital and operation will help your child.
After completing admission paper work your child will be
assessed by nursing staff and then seen by the anaesthetist. In
general the order of operating list is from youngest to oldest
child. If your child is having their operation later in the list it
is still vital to arrive on time to see the anaesthetist before the
start of list so that s/he is able to start the list on time and
prevent disruptions during the list. As there is always some
waiting involved bringing some toys or books to keep your child
amused is a very good idea.
In general one parent will be able to go with your child into
the anaesthetic room or operating theatre. Children can be
anaesthetised ("put to sleep") with either gas (given by mask) or
by an injection. Please discuss these different methods of going to
sleep with the anaesthetist during the pre-operative assessment.
Your child will go to sleep quite suddenly and it is not uncommon
to feel a bit helpless and distressed by this. If you feel faint
sit down on the floor. We won't be upset and may not catch you if
you faint while standing!
Once your child is asleep you will be accompanied out of the
anaesthetic room to the waiting room. If you go for a walk while
your child is being operated on please return to the designated
waiting area at the time suggested so that I can speak to you as
soon as the operation is completed. Most squint operations take
between 30 to 70 minutes.
Most often no patch is required. There may be slightly blood
stained tears for a few minutes after the operation and a little
dried blood on the eyelids. This can be washed off with saline or
cool boiled water. The eyes will be blood-shot and appear "bruised"
over the muscle(s) that were operated on and this will increase
over the fist two days after the operation. The redness will go
over 1 - 2 weeks though there may be a persisting pink area on the
white of the eye for weeks to months after a squint operation,
especially if a muscle was tightened (resected). The eyes may
appear much better aligned as soon as they are opened after the
operation. Often there will be noticeable variation in the
alignment with the eyes moving in and out a bit as the brain
"learns" to control the eyes following the surgery. This variation
usually settles in days to a week or so.
Your will stay in hospital until both you and the nursing staff
are happy for your child to be discharged. This is generally two to
three hours after the operation is finished. If you live more than
two hours drive from hospital it is recommended you stay closer to
the hospital for the first night.
Young children (less than 2 years old) are often keen to drink
immediately after waking. Once the recovery room nursing staff or
ward staff are satisfied your child is sufficiently "awake" you
will be able to offer your child a drink. In older children small
volumes of drinks and then solid food should be offered once your
child is awake. Most older children will only eat small amounts of
food during the afternoon and evening after the operation. Over
feeding soon after the operation may increase the chance of
vomiting in older children.
Most children will only require paracetamol for pain relief. For
children younger than one year often no pain relief is needed after
leaving hospital. Pain relief should be given if a younger child
will not settle with soothing and feeding and in an older child if
you believe there is pain. Codeine can be given if the pain is
severe in older children. This may increase the risk of vomiting
slightly. For children having surgery on one eye only an injection
of local anaesthetic may be given to lessen pain after the
operation. Following such an injection the vision will be poor in
that eye for several hours and a patch will be placed over the
Often there is some blurring of vision for a few days after
surgery. Younger children will not notice this. Double vision
(diplopia) is common after squint surgery. It is usually quite
transient. A small number of older children (usually over 10 to 12
years of age) will experience more troublesome double vision. Light
sensitivity (photophobia) is common after squint surgery. Older
children will benefit from sunglasses and younger children should
be kept out of direct sunlight for a few days if this seems to be a
If any of these problems occur please contact your
ophthalmologist or hospital medical staff promptly.
The first post-operative visit is generally the next working day
after the surgery and the second approximately one month later.