What to Expect in Strabismus Surgery
One of the hardest things a parent can hear is that their child's eyes might need surgery. This prospect can be intimidating until you understand the process of the surgery and the skill of modern-day ophthalmologists.
To help ease any nerves you may be experiencing about a prospective surgery, we will be sharing some simple explainers on common eye surgeries for kids, starting with Strabismus.
What is Strabismus?
Strabismus is a condition in which the eyes don’t point in the same direction at the same time. In cases of strabismus one or both eyes may turn inward (esotropia), outward (exotropia), upward (hypertropia), or downward (hypotropia) either sometimes (intermittent) or all the time.
To avoid seeing double, the brain may ignore the image from the eye that is not focused on the object and this prevents that eye from developing properly, leading to Amblyopia. You may have heard this condition referred to as lazy eye because of the reduced vision in one eye, but here at Speckles we prefer to call it the “curious eye”. To learn more about Strabismus, check out this blog post.
How is Strabismus corrected?
When your child is first diagnosed with Strabismus, it is likely your ophthalmologist will recommend occlusion therapy (AKA patching) to improve eye coordination and strength. This can include a program of activities that reinforce the eye-brain connection and may be completed while patching the stronger eye, allowing the "curious eye" to strengthen and correct itself.
If occlusion therapy is not successful in correcting the curious eye, your child may need to undergo surgery to change the length and position of the muscles around the eyes. This surgery is often done as an outpatient procedure and requires general anaesthesia, so you can take comfort in knowing your child will be asleep during the procedure.
Before the surgery, your ophthalmologist will take measurements of your child's eyes that inform the adjustments that will need to be made. Once asleep, they will use an eyelid speculum to hold the eye open and will make a small incision in the sclera (the white part of the eye) so they can reattach the muscles into a more effective position. The incision in the sclera is then closed with dissolvable stitches and your child will be moved to the recovery room to slowly wake up. It is estimated that 70 to 85% of kids will have long-term stable eye alignment after one surgery.
How to prepare your child for surgery.
The best way to alleviate fears of surgery for kids and parents is through information. It is a good idea to give your child a general idea of what they will experience and why it is important, however, the delivery of this information is important.
We recommend that you start by explaining to your child what Strabismus is and how the surgery will give them a better chance to use both of their eyes equally so they can see the world better. You can use calming words to explain that the doctor will put them to sleep with medicine so they will not feel or remember what happens during the surgery. Ask your surgeon what precautions to take before and after the anaesthesia, such as not eating or drinking and explain these to your child as well. If your child has fears about waking up during surgery, or not waking up at all, reassure them that these thoughts are completely normal, your surgeon is experienced and that complications from anaesthesia are very rare.
Depending on your child's age, it may not be appropriate to explain what happens during the procedure, as this can lead to anxiety. However, we encourage you to provide the opportunity to your child to ask questions and if this topic arises, stick to using reassuring language like "the doctor will use their special tools to readjust your eye so that it sits in a better position to help you see".
It is also important to explain to kids what they may experience after the surgery, which are listed below!
What to expect after surgery.
It is easy to become alarmed or anxious when your child is in pain so we encourage you to remember that eye muscle surgeries are common and these side effects are normal. You can expect your child to experience
- Grogginess or nausea from the anaesthesia
- Pain in the eye or eyes that were operated on
- Redness in the eyes
- Pink discharge from the eyes and nose
- Double vision
- Aftercare such as applying ointments or eye drops
You can relieve your child's pain through medicines like Panadol, just remember to always read the label and use only as directed. Other ways to calm and comfort your child include dimming the lights and popping on an audio book, holding a cool washcloth on their closed eye to reduce swelling or simply lying down with them while they fall asleep. Other precautions to take after surgery and explain to your child include washing your child's hands regularly to avoid infection and avoiding rough play, swimming or getting water in the eye for at least 1 week after surgery.
When should you be concerned?If you notice any of the following symptoms, we recommend you take your child to their eye care professional or your local hospital for aftercare.
- Signs of infection, such as green or yellow eye drainage
- Vision loss
- Pain, swelling, nausea and vomiting that won’t go away
- Fever higher than 38º