It is a condition in which the position of the eyes is not parallel, the eyes are not well aligned. Strabismus may occur in one or both eyes, constantly or intermittently.
4-5% of children born in one year suffer from strabismus. 50% of them can develop amblyopia (low vision or lazy eye). Adults can get strabismus due to various causes and its occurrence is directly proportional to age, so as we age, we are more likely to acquire strabismus
The obligatory stages in the treatment of strabismus are:
- Correction of dioptres by means of permanent glasses if the patient has refractive errors
- Recovery of vision in the weak eye by occlusion or penalization if there is amblyopia and the patient is a child
- Alignment of visual axes by operation if the angle of deviation WITH THE GLASSES ON (or contact lenses) exceeds the physiological limit at which the two eyes can function harmoniously together.
We use a unique surgical technique in Romania that involves extremely small incisions, with very fast healing and without scars. Strabismus operations are performed under conditions of general anaesthesia for both children and adults.
In some situations, we use local or topical anaesthesia (drops) only in adults.
About the operation
Warning! The intervention for strabismus is delicate and requires a surgeon specialized in this type of surgery, otherwise the failure to know all aspects results in unwanted and sometimes irreversible results.
The surgery technique consists in the weakening of the hyperactive muscles (retroposition) and / or the strengthening of the hypoactive muscles (shortening, advancing or folding). The technique used in OFTAPRO involves small incisions (3-4 mm), which is why recovery is very fast.
There are also more complicated surgeries, especially for less common strabismus, where more muscles need to be operated or more complicated surgical techniques other than those mentioned are used, that only certain surgeons can perform. The decision belongs entirely to the strabismus doctor specialist and the pre-surgery plan can be modified during the intervention according to the findings during the intervention.
Strabismus in the baby and young child
The idea is that the baby has a period of physiological instability, in which it is “normal” for the eyes to deviate intermittently from the normal position. The deviations (strabismus) that can be considered “normal” are the intermittent ones, usually divergent (outwards) and which disappear after the age of 6 months, the position of the eyes remaining stable and parallel. Other deviations, permanent, large, visible and not disappearing after this age, should be treated early.
Late examination can result in deep amblyopia or, worse, strabismus can hide the presence of serious organic diseases: congenital cataracts, malformations, retinal or nerve disorders, tumours. Examination of the child under one year requires the presence of a specialist ophthalmologist for children.
The recommendation of specialists is that the baby’s strabismus be surgically corrected before the age of 18-24 months but not before correcting the dioptres by means of glasses and performing the occlusive treatment in order to obtain a similar performance of the two eyes.
What is the optimal age for strabismus surgery?
The optimal age for surgery depends on the age of onset of strabismus.
• Congenital strabismus – which occurs in the first 6 months of life – surgery should be performed as soon as possible, even under the age of 1 year, otherwise the child no longer develops normal binocular vision. All studies indicate better functional outcomes in children under 24 months of age. It may take two or three surgeries until perfect alignment is obtained.
• Strabismus that appeared later – after the exhaustion of other forms of treatment: glasses, occlusion – if the deviation persists – switch to surgical treatment. It is ideal for this surgery to be performed before the age of 4 and a half, but the shorter the imbalance period (between the appearance of strabismus and surgery), the better the results.
Strabismus in adults
The most common adult strabismus is residual strabismus (which were subject to surgery but not completely corrected) or consecutive (strabismus that was initially of a certain type but which after the surgery/surgeries changed its appearance) but there is also strabismus that starts in adulthood with various causes and which results in DIPLOPIA ( double vison). Adults do not have the ability to ignore one of the images in most situations when they previously had normal binocular vision and therefore, they close one eye or look for a compensatory position in which they manage to overlap the images.
Usually, in old strabismus, patients do not have diplopia because they had the time to adapt their brain to this situation but it can occur postoperatively after alignment of the visual axes.
When a patient addresses the strabismus specialist because he/she has a double vision and he/she developed an acquired strabismus, he/she has all the chances that his/her problem can be solved.
There is a misconception that strabismus is difficult or impossible to treat in adults.
In reality, adults have treatment options:
- glasses with prisms – in minimal deviations – have no effect in large deviations.
- surgical treatment.
- botulinum toxin-it is used especially in paralysis of the extraocular muscles but also in multiple strabismus with an unsatisfactory result after surgery, in case of small or intermittent deviations.
The purpose of surgery:
- alignment of the eyes.
- the elimination or amelioration of diplopia if it exists
- reducing ocular fatigue.
- reducing or eliminating the vicious position of the head.
- increasing self-esteem and easier social integration
At OFTAPRO you have access to the most experienced team in the country in strabismus surgery
Postoperative diplopia (double vision after strabismus surgery) is a very rare complication as permanent phenomenon. It is very true that after changing the position of the eyes the patient can have double vision but usually the phenomenon is transient, can last for hours or days and generally disappears in 99% of cases in the first 2-3 weeks postoperatively. Most patients do not have it for more than a few days or do not notice it at all. Obviously, this is true for interventions performed in the right conditions by the strabismus specialist and after which a good postoperative alignment is obtained. There are predictive tests that can estimate the risk of postoperative diplopia.
In the case of diplopia acquired as a result of a recent strabismus, the purpose of treatment is to resolve diplopia.
Is another surgery required?
If the strabismus angle is large, in paralytic or thyroid strabismus – after a first surgery it may be necessary to correct the remaining angle, so a second surgery, performed on other muscles, without this fact representing a failure of the first surgery.
The surgery is performed under general anaesthesia, under conditions of perfect sterility. After the surgery, children go home without a bandage, as do most adults. After more complex operations, it may be required to wear a bandage for a few days.
The first postoperative check-up is done the next day.
What risks and complications can occur?
In any surgery there are -theoretically- risks of anaesthesia and surgery. In the strabismus operation the risks are minimal:
- Diplopia (double vision) after the operation is transient in 99% of cases
- Postoperative infections are prevented by drops with antibiotics, anti-inflammatory and strict maintenance of eye and hand hygiene. It manifests itself with: swollen eyelid, red eyes, muco-purulent secretion and may progress to cellulite.
- Intraoperative incidents may be prevented by means of a correct surgical technique.
- Supra or sub-corrections of the strabismus angle that require another intervention. The risk is higher in case of complex, high-angle strabismus and in case of those with onset under the age of 6 months. Sometimes the surgical treatment has to be performed in stages due to the particularities of the case.
Do you use the laser in strabismus surgery?
Warning! The laser shall NOT be used in strabismus surgery because it has no application. The laser is used in ophthalmology for other types of surgery in which you have to remove certain tissues. In the strabismus surgery all tissues must maintain their structure and integrity for a functional result and to allow re-intervention.
Statements such as “laser-operated strabismus” are misleading, most often for commercial purposes.
