Eye Muscle Surgery

Whenever possible we treat eye misalignment conservatively. For example, in many children who are farsighted, crossing of the eyes can be controlled with glasses instead of surgery. In many adults, symptoms of double vision can be controlled with prisms instead of surgery. However, there are some eye misalignment problems that conservative measures cannot help, and in these cases eye muscle surgery is necessary.

If you or your child does need eye muscle surgery, though, note that Dr. Young is the most experienced eye muscle surgeon in the Triad, having done thousands of eye muscle surgeries. We treat every case as we would want our family to be treated, doing our very best to achieve the goal of a safe surgery and a good outcome.

Common Myths and Misconceptions Regarding Strabismus Surgery
(courtesy of Eric Crouch, MD, Norfolk, VA)

Many of the reasons patients are told not to have strabismus surgery are listed below:

myth: “Sometimes the eyes are not straight after surgery and your child will have to have another surgery.”
Your child may or may not need additional surgery following strabismus surgery, depending on several factors. If your child is able to reestablish some fusion (using both eyes together), the chances for long term alignment are much better. The type of strabismus is also a major reason why a child may need more than one surgery, due to the underlying genetics or predisposition for misalignment.

myth: “You will need 6 months of vision therapy for $3000 to get your eyes strong enough for surgery.”
There is good evidence for the benefit of eye exercises for “convergence insufficiency”, a specific form of eye misalignment in which the eyes deviate outward at near but not at distance. We always recommend convergence exercises instead of surgery for appropriate patients with convergence insufficiency. However, there is no good evidence that eye exercises or "vision therapy" works for other forms of eye misalignment, either before, after, or as an alternative to surgery.

myth: “I heard my eyes will be removed from my head during the surgery.”
The eyes are not removed from the head or orbit during surgery. The surgery is a microscopic surgical technique of altering the position and tension of the eye muscles.

myth: “It’s not worth having surgery after childhood” or “you will probably have double vision forever.”
There are many benefits to strabismus surgery, even in older children and adults. It is uncommon that a patient has to accept double vision due to ocular misalignment.

myth: “I heard surgery is only cosmetic and not covered by insurance.”
Strabismus surgery is considered reconstructive surgery, and is no difference in principle than having any other type of reconstructive surgery. Strabismus surgery is NOT cosmetic and is generally covered by insurance. In contrast, vision therapy is generally not covered by insurance due to the lack of evidence-based medicine supporting vision therapy.

myth: “I heard you can not see after strabismus surgery.”
Vision loss following eye surgery is extremely uncommon, particularly strabismus surgery. The eye muscles are external to the internal structures of the eye; therefore intraocular infection is very common. Estimates of an eye infection after strabismus surgery are about 1 in 30,000 cases. Most patients have similar visual acuity after surgery. The benefits are improved alignment and rehabilitation of binocular vision.

myth: “I was told wearing a patch is better and cheaper than surgery.”
A patient, whether child or adult, may wear a patch to avoid double vision. For a child, wearing a patch is more often employed to treat amblyopia (abnormal visual development.) However, wearing a patch to occlude a misaligned eye is not a practical long term solution when surgery can improve binocular function.

myth: “In order for surgery to work the eyes have to be perfectly aligned and vision therapy more likely results in improved vision.”
This is another common misconception or myth regarding strabismus surgery. The eyes may be perfectly aligned following surgery, or may be within a range that the brain can use underlying convergence an divergence amplitudes to achieve eye misalignment. Even a reduction in strabismus is still an improvement in the overall alignment.

myth: “Surgery does not last.”
Patients can have varying long-term alignment. Children and adults who are realigned can have decades of straight eyes and improved binocular vision. The duration of realignment varies depending on the patient’s ability to fuse, underlying medical conditions and health, and surgical response.

myth: “I heard multiple surgeries are required.”
In general, patients can achieve good ocular alignment with one or two surgeries. Some patients require more surgeries due to the particular type of strabismus or underlying medical conditions. Your surgeon can discuss the chances of future surgeries based on the type of strabismus.

myth: “I was told my eyes would never look normal.”
Without surgery the condition will not spontaneously improve and will generally worsen with time. For children in particular, the developing visual system is particularly susceptible to ocular misalignment and develops abnormal neuroadaptation, such as suppression, loss of binocular vision, and amblyopia. With surgery, improved eye alignment can improve visual function. The incisions are often difficult to detect after the eyes have healed.

myth: “I was told I am too old for surgery” or “I was told my child is too old for surgery.”
Both children and adults can have significant improvements in visual function and alignment following surgery. There is neither a minimum nor maximum age for surgery. The benefits of surgery for adults are also applicable for children. As with many conditions, the sooner intervention is initiated the better for long-term results.

myth: “I was told my child would outgrow strabismus.”
Unfortunately, most children do not outgrow strabismus, particularly constant strabismus. Children with intermittent strabismus during the first 6 months of life may outgrow the strabismus as the visual system develops. However, any constant strabismus during the first year of life or intermittent strabismus after 6 months of age will generally progress and result in abnormal visual development. Surgical correction can assist in visually rehabilitating and restoring ocular alignment. Additionally, children who acquire strabismus after 6 years old can be very serious and require urgent evaluation.

myth: “I was told surgery could not restore binocular vision.”
The patient’s response to surgery varies, but many patients can have improved binocular vision after surgery. Without surgery, binocular vision will not spontaneously return.


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