Your child's doctor has recommended surgery on the eye muscles to improve your child's strabismus.
What happens during strabismus surgery?
Before the surgery, your child will have a sleep medicine called a general anaesthetic. This will make sure your child sleeps through the operation and does not feel any pain.
The surgeon will tighten the weak eye muscles of your child's eyes and/or loosen the stronger muscles so the eyes are positioned better. Special stitches will hold the eye muscles in their new position. These stitches are absorbable so they do not need to be taken out. They will dissolve on their own over the first six to eight weeks after surgery.
The surgeon will not cut the skin around your child's eye, take the eye out of its socket, or use any lasers during the operation.
What to expect after your child's strabismus surgery
Eye patch
Your child's eye(s) may be patched after the surgery. If a patch is put on, the nurse usually takes it off before your child is sent home from the hospital. If the patch is needed for a longer time, it is usually for one night. Your child's doctor will tell you when to take it off.
Redness and swelling
Your child's eyes may be red and slightly swollen for several weeks. The redness and swelling should start to decrease after a couple of weeks. If you notice the swelling or redness getting worse after this time, please call your child's ophthalmologist (eye doctor).
Pain or discomfort
Your child may have some discomfort or pain in the operated eye. Ask your child's eye doctor if you can give medicine to relieve the pain or discomfort. After the surgery, the nurse in the post-anaesthesia care unit will inform you when pain relief medication was last given. Usually, the pain medication is only needed for a few days after surgery.
Ice water compresses
Some eye doctors will also suggest putting cool water or ice water compresses on the eyes to ease discomfort and reduce the swelling. Ask your child's eye doctor if your child can use cool compresses.
To make a cool compress, follow these steps:
- Always wash your hands before and after you touch your child's eyes.
- Fill a clean container with cold water. Cool tap water is fine. If you have well water, boil it and cool it in the refrigerator before you use it. Ask your eye doctor if crushed ice or ice cubes can be used to make the water even colder.
- Soak a clean face cloth in the water.
- Squeeze any extra water out of the cloth, then place the cloth on the swollen eye(s).
- Leave the cloth on the eyes for no more than two minutes at a time.
- Repeat a few times.
- Ask the eye doctor how often your child can have a cool compress. Several times a day for the first one or two days is often fine.
Double vision
Your child may see double ("two of everything") after the operation. This will almost always go away in the first few weeks after the surgery as the swelling goes down and the child gets used to the new position of the eye muscles. Call your child's eye doctor if your child cannot see as well as they did before or if the double vision does not go away.
Pinkish or light yellow tears
Your child may have small amounts of slightly pinkish tears or blood-tinged discharge from the eyes for a couple of days after the surgery. Your child may also have clear light yellow tears at times.
If the discharge continues after a couple of days or if it becomes bloodier, call your child's eye doctor.
White discharge or mucus
You may also notice that your child has thin whitish discharge or mucus around the eyes, especially after they wake up from sleep. This is entirely normal as the eyes heal. You can clean away this mucus with a face cloth rinsed in warm water. Put the face cloth on the eyes for one to two minutes and then gently wipe off the discharge.
If the discharge changes to yellow or green, call your child's eye doctor.
The cornea and pupil should look normal
The clear covering of the eye, called the cornea, and the black pupil should always look the way they normally do. If they look different, your child's eye should be checked by an eye doctor.
How to care for your child after the strabismus surgery
Antibiotic and cortisone drops
Sometimes, the eye doctor will order antibiotic drops or a combination of antibiotic and cortisone drops for the operated eye(s). If your child needs eye drops, your child's eye doctor will let you know. Please remember to pick up the prescription. The drops are usually only needed for the first two or three weeks after the operation. They are not given more than three or four times per day.
Gentle play only for the first week
For the first week after the surgery, your child can do light activities such as gentle playing indoors, using computers and watching TV. Your child will need to avoid rough activities, playground activities, sandbox play, gym or contact sports for at least two weeks after the surgery. Ask your child's eye doctor what activities your child is allowed.
Baths and showers
Your eye doctor will instruct you on when your child can have a bath or shower after the surgery. Your child may have a bath instead of a shower five days after surgery. Wash below the neck. Avoid hair washing for the first five days after the surgery, as soap or shampoo can go into their eyes. Avoid eye rubbing. Only wipe your child's face with a clean face cloth and water.
School and day care
Children should not go to school or day care for the first two days after the surgery. Tell your child's caregiver or teacher about any activity restrictions.
Swimming
Avoid swimming for three weeks after the surgery.
Follow-up appointments after the strabismus surgery
Follow-up appointments are as important as the surgery itself. These appointments are usually scheduled as follows:
- during the first week after surgery
- six to eight weeks after surgery
- three to six months after surgery.
Check with your child's doctor about when the first follow-up appointment should happen.
Write the date and time of the first appointment here:______________________
Glasses or patching after surgery
If your child needed glasses before surgery, they will most likely still need them after the surgery. While surgery will help straighten your child's eyes, it is only one part of the treatment. Surgery alone is not a complete cure for every child. Sometimes, an eye will also need patching after an operation.
If your child's eye needs patching, your child's eye doctor will tell you and give you the instructions.
If you have any questions or concerns, please call the eye doctor who operated on your child's eyes.
Write down your child's eye doctor's name and phone number here:
Name: ________________________________
Phone number: __________________________
When to see a doctor
Call your child's eye doctor if, after the operation:
- your child cannot see properly
- your child has a fever
- you see abundant bleeding in your child's eye patch/dressing
- your child's pain gets worse and does not improve despite pain medication
- your child's eye suddenly gets more puffy
- your child has any green or yellow discharge
If your child's operation took place at The Hospital for Sick Children, please page the ophthalmology resident on-call. You can page the ophthalmology resident on-call through The Hospital for Sick Children Locating at 416-813-7500.
At SickKids:
Every eye doctor has their own instructions for what to do after strabismus surgery. Please make sure you receive a copy of your eye doctor's instructions from your doctor's co-ordinator.