Chapter 10: How is Strabismus (Eye Muscle) Surgery Performed?
A Patient & Parent Guide to Strabismus Surgery
George R. Beauchamp, M.D.
What is done in strabismus surgery should make sense to you, and reasonably address the condition as you understand it. For example, if an eye is turned inward, one can logically conceive that the muscles that pull it inward are either overacting or too tight. Therefore one should do something to weaken the pulling power, or loosen, that muscle. There are a number of methods to weaken a muscle’s pulling power, including moving it (generally called a recession) or, in certain instances, severing all or a portion of it. Strengthening a muscle’s action may be performed by tightening it (generally called a resection) or by ―borrowing‖ muscle power from and adjacent muscle. Transposing all or portions of muscles may be of benefit when there are certain patterns to strabismus, or when a muscle is absent or neurologically weakened. The following is a summary of commonly performed operations for some common conditions. Be aware that there is more than one method for effectively treating strabismus surgically; and your or your child’s condition may warrant something varying from these examples.
For esotropia:
o Recession of the medial rectus muscle of each eye
o Recession of one medial rectus and resection of one lateral rectus
o For very large angles, combinations of the above
For exotropia:
o For small angles of deviation, recession of one lateral rectus muscle
o Recession of the lateral rectus muscle of each eye
o Recession of one lateral rectus muscle and resection of one medial rectus muscle
o For very large angles, combinations of the above
For hypertropia:
o Recession of one or more vertical rectus (superior and inferior) muscle(s)
o Weakening of one or more oblique (superior and inferior) muscle(s)
o For inferior obliques, common operations include recession and myectomy
o For superior obliques, common operations include tenotomy, tenectomy, lengthening with spacer(s), and recession
Particular circumstances may require:
o Transposition of a muscle and its insertion
o Detaching a muscle
o An assistant or co-surgeon
Additional Methods for Consideration
Exercises: Eye exercises, sometimes called orthoptics or vision training, have proven to be of some value in strabismus care. In some instances, exercises may be used as a temporizing or preparatory strategy prior to surgery. However, when the amount of the strabismus is substantial, the deviation is not likely to be overcome with exercises.
Botulinum toxin: Botulinum toxin may sometimes be used as part of or an adjunct to surgery. For additional perspectives, please see the section on alternatives to surgery.
Adjustable sutures: Some surgeons will use adjustable suture techniques in adults and older children routinely, some in selected circumstances, and others rarely if at all. Reasonable and experienced surgeons continue to debate the relative merits of these procedures. The potential merits seem intuitive, i.e., if the correction is not proper, it may be adjusted immediately after the surgery, hopefully to avoid additional procedures.
There remain unanswered questions. The adjustment is generally accompanied by significant discomfort; there may be some imprecision in where the muscle actually reattaches to the globe, and some changes in eye position continue to occur during the healing process. Hence, it is not definitively known the degree to which (and in what ways) adjustments may be of benefit, or the necessary and sufficient criteria for their application. This dilemma would benefit from a prospective controlled trial of comparison in patients with similar conditions performed by the same surgeons. Your surgeon will share with you her or his recommended choice of technique.
Read Timing of Strabismus (Eye Muscle) Surgery
If you would like to arrange a pediatric or adult eye consultation with an ophthalmologist at ABC Eyes, please submit an online appointment request or call one of our offices:
ABC Eyes
Dallas Office 214-369-6434
Grapevine Office 817-329-5433
Plano Office 972-797-1200
