Surgical Alignment of the Eye Muscle

The muscles of the eye allow for proper vision alignment, and may be affected in patients with strabismus or nystagmus. Located near the surface of the eyes, the muscles act like elastic bands that hold the eyes in place and help them change position as needed. They are located around the eye and are attached on one end to the sclera, which is the white portion of the eye, and on the other to the eye socket. In some patients, the muscles do not align the eyes properly and this may lead to an imbalance in vision.

Causes of a Misaligned Eye

  • Strabismus or a family history of strabismus
  • Grave's disease
  • Myasthenia Gravis
  • Brain tumor
  • Stroke
  • Aneurysm
  • Head Injury
  • Orbital fracture
  • Low vision

Symptoms of a Misaligned Eye

If left untreated, many people with vision alignment problems will begin to experience the following symptoms:

  • Double vision
  • Loss of normal binocular vision
  • Loss of depth perception
  • Eye fatigue
  • Difficulty reading

Binocular vision is the way that the brain incorporates the two slightly varied images it receives from the eyes and creates the one three-dimensional image that we see of our surroundings. If muscle issues cause these images to differ too greatly, this ability is lost. Double vision occurs when the brain cannot properly integrate the two differing images and both appear.

Treatment of a Misaligned Eye

Since strabismus and other misalignment issues of the eyes often begin early in childhood, surgery is typically recommended for children. It can prevent further vision problems and vision loss from occurring. If the condition is not treated surgically during childhood or it develops in adulthood due to eye injury or another cause, it can still be successfully treated through corrective muscle surgery.

The Surgical Procedure to Correct a Misaligned Eye

Surgery to correct eye muscle abnormalities involves detaching and reattaching muscles to realign the eyes and restore proper vision. The incision takes place in the white of the eye. The muscle causing the misalignment is then removed and reattached in a better position. It is held in place with very small adjustable sutures. Sometimes a muscle needs to be weakened, so the surgeon moves it in such a way that permits the muscle to stretch and relax. Other times, a muscle requires tightening, which involves shortening the length of the muscle as it is moved. Prior to the surgery, the doctor will examine and measure parts of the eye to determine exactly which of the six muscles of the eye are affected and how they need to be altered.

During the procedure, once repositioning is complete, dissolvable stitches are used to close the incision site. Rarely is there a noticeable scar left on the surface of the eye. This procedure is performed on an outpatient basis under general or local anesthesia, and usually takes about 90 minutes to perform. The eye remains in its socket in its normal position throughout the entire surgery. Afterward, the eyes should begin to move together in tandem and appear to both be looking at the same object, but results can vary depending on each patient's individual condition.

While it is successful in the majority of cases, there are a small percentage of patients who will require a second round of surgery several months after the first. If the muscle shifts its position or a slight undercorrection or overcorrection took place, it can cause the eye to misalign again to some extent. If any of these are the case, another procedure can be scheduled to fix the problem.

Post-Surgical Correction of a Misaligned Eye

Most patients experience blurry vision and some level of discomfort in the eye for several days after the procedure. Over-the-counter pain relievers such as acetaminophen are usually quite effective in managing any pain. The eye often feels irritated or sore and the region around the eye may become tender and swollen. There may be some redness in the eye immediately following surgery and then later a yellowed cast may appear, similar to a bruise.

In addition, some patients, especially older children and adults, have double vision after the surgery. This typically will not last for more than a few weeks. Eye drops are frequently required for a one-week period following eye muscle corrective surgery. The majority of patients can return to work and all normal activities within one week.

Risks of a Misaligned Eye Surgery

Eye muscle surgery is a very safe procedure with few associated complications. Any surgery does present some risk. Those most common to eye surgery are complications from anesthesia, a shifting of the eyelid and injury to the eye, which can result in temporary or permanent vision loss.

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