Squint Eye Surgery

Squint eye surgery, or strabismus surgery, is a medical procedure performed to correct misalignment of the eyes, often referred to as crossed eyes or lazy eye. Though it is common in infants and children, it can occur at any age. Adults may also develop the condition. There are various types of squints, including hypertropia (upward deviation), esotropia (inward turning of an eye), exotropia (outward turning of an eye), and hypotropia (downward deviation).

Squint eye surgery can be tailored to address the specific type of misalignment. During squint operation, the ophthalmologist or eye surgeon makes adjustments to the eye muscles to ensure both eyes are correctly aligned, allowing the patient to have better binocular vision and a better cosmetic appearance. The primary goal of the surgery is to preserve or restore as much visual function as possible. The specific techniques used can differ depending on the type and severity of the strabismus. It's essential to consult with an eye specialist to determine if this surgery is required and suitable for your condition.

Squint eye surgery is typically suggested when non-surgical treatments, such as eyeglasses, eye patches, vision therapy, etc, have not been effective in correcting the misalignment.

About 5% of the population has squint. If your eyes are misaligned and other treatments haven't worked, an eye care provider may recommend strabismus surgery. Candidates for squint surgery may include the following:

• People with double vision: Double vision occurs when an individual sees a double image where only one should exist. Squint eye treatment can alleviate double vision caused by misaligned eyes.
• Children with strabismus: Most squints in young children may be associated with weak eyesight. Pediatric squint surgery is often performed to correct misaligned eyes in children to prevent long-term vision problems. Sometimes, surgery in one eye is adequate, while surgery in both eyes may be needed in case of significant deviations. The doctor will also discuss with you the possibility of needing more than one surgery for optimal cosmetic and functional outcomes.
• Adults with strabismus : Squints in adults can form due to some medical problems such as thyroid, diabetes, myasthenia gravis, brain tumors, strokes, head trauma, etc. Some adults with strabismus may opt for surgery to correct eye alignment, which can help with binocular vision and self-esteem.
• Amblyopia (Lazy Eye): Amblyopia, typically known as lazy eye, is an issue with visual acuity or eyesight. One eye or both eyes may be affected and have poor vision. Squint is the most common cause of amblyopia, and amblyopia often presents with strabismus. In cases where squint is associated with amblyopia, squint eye surgery may be considered. Squint surgery can help align the eyes and enhance the vision in the lazy eye.
• Non-responsive to other treatments: Squint eye surgery is often recommended when non-surgical treatments like eyeglasses, vision therapy, or eye exercises have not successfully corrected the misalignment.

It's important for anyone considering squint surgery to consult with an ophthalmologist or eye professional who can assess their specific condition and determine if surgery is required and appropriate.

Here are some squint eye tests that your doctor may perform for squint eyes or strabismus:

• Visual acuity assessment: This test estimates the sharpness of your vision. It often involves reading from an eye chart, where the smallest line of letters you can read accurately is recorded. Visual acuity is expressed as a fraction, with 20/20 indicating normal vision and the second number (e.g., 20/40) indicating the distance at which you can see what an individual with normal vision can see at 20 feet.
• Cover test: The cover test is performed to detect misalignment of the eyes. It is conducted by having the patient concentrate on an objectwhile one eye is covered and then the uncovered eye. The doctor monitors how the uncovered eye moves when the cover is alternated. If one eye shifts to fixate on the target when it's uncovered, it may indicate a squint.
• Ocular alignment assessment: This examination evaluates how the eyes work together to concentrate on an object. A light or a penlight may be used to evaluate eye movements. The eye doctor observes the alignment of the corneal light reflex (Hirschberg test) or target movements (Krimsky test) to check for strabismus.
• Refraction test: A refraction is an eye examination that estimates an individual's prescription for eyeglasses or contact lenses. In this test, you'll sit in a chair with a special device (called a refractor) attached. You'll look through the device and concentrate on an eye chart 20 feet (6 meters) away. The device has lenses of different strengths that can be moved into the view. The doctor will then ask if the chart appears more or less clear when different lenses are in place. The results of the test depend on your responses. This assessment determines if any refractive errors (e.g., nearsightedness, farsightedness, or astigmatism) lead to the squint.
• Prism testing: The prism cover test is an objective measurement in measuring strabismus. Ophthalmologists use it to measure the vertical and horizontal deviation. It includes both manifest and latent components. Manifest is defined by the eye deviating constantly or intermittently. In contrast, latent is where the deviation is typically controlled but becomes present when the eyes are dissociated.
• Stereopsis test : Stereopsis is the ability to perceive depth or 3D vision. Tests like the random dot stereogram assess stereopsis by requiring patients to identify 3D shapes from patterns. Poor stereopsis can be an indicator of squint.

These squint eye tests provide a thorough evaluation of the eyes and help determine the presence and characteristics of strabismus, as well as any underlying causes or associated conditions. The results of these tests guide the treatment plan and approach to managing squint.

Treatment options for squint can be divided into surgical and non-surgical techniques. Here's an overview of both:

Non-Surgical Management For Squint Eyes:

Non-surgical treatment options for squint can be effective, specifically in cases where the condition is mild or due to certain underlying causes. It's important to note that the success of non-surgical treatments can vary depending on the specific type and severity of squint. Here are some common non-surgical treatment options:

• Eyeglasses or contact lenses: In cases where squint is related to refractive errors, prescription eyeglasses or contact lenses can help correct the vision imbalance. This may eliminate the need for the eyes to squint to compensate for poor focus.
• Vision therapy : Vision therapy for squint treatment is one of the most effective non-invasive treatment options. It is equally effective for children and adults alike. Vision therapy focuses on using a variety of exercises and medical aids to strengthen the eye muscles of the weak eye. In the process, it improves squint eye symptoms like double vision, issues with depth perception, 3D vision, and cosmetic appearance of the pupils.
• Prism lenses: Prism lenses are a very popular non-surgical treatment option for squint.People who have squintoften suffer from double vision, which could cause amblyopia and permanent loss of vision in the weak eye.Prisms are used in glasses and use their refractive propertiesto help correct double vision and train the eye. Since squint causes one of the eyeballs to turn outward or inward, it causes problems in your vision. Doctors compute the difference angle between your eyes and correct that using prism glasses. Prisms are used to refract the light entering the affected eye to correct its vision and stop double vision from occurring. This is done by calculating the difference angle and making prism glasses made precisely to the degree of difference. It is largely like prescription glasses, but these glasses help you stop the double vision. Over time, prism glasses can help you strengthen your eye, train it to be stronger, and correct its visual errors.
• Patching or occlusion therapy : Patching the stronger eye or using atropine drops to blur vision in the stronger eye can boost the weaker eye to work harder and develop better vision. This is often used in children with amblyopia (lazy eye), which can be associated with squint.
• Pharmacological therapy: Pharmacological therapy can also be used to treat squint patients with miotics like echothiophate iodide as an alternative to glasses or lenses. This therapy forces the patient to accommodate the squint eye forcefully. This therapy is more effective for children with moderate squint.
• Chemo denervation: The injection of botulinum toxin type A can be used as an alternative to conventional incisional surgery in selected squint patients. In this therapy, temporary paralysis of the extraocular muscles causes a change in eye position. This change can result in long-lasting and permanent alterations in ocular alignment. Typically, one injection is sufficient to produce the desired results.

Surgical Treatment For Squint Eye:

There are several surgical treatments for squint eyes, and the choice of procedure depends on the type and severity of the condition. Here are some of the common surgical treatments:

• Rectus muscle surgery : Rectus muscle surgery is a type of eye surgery that involves the adjustment of the rectus muscles in the eye to correct squint. The rectus muscles are a set of six extraocular muscles in each eye that control the eye's movement. In this surgery, an ophthalmologist creates tiny incisions in the eye's conjunctiva (the thin, transparent membrane covering the white part of the eye) and adjusts the length or position of one or more rectus muscles. This procedure changes the eyes' alignment, bringing them into proper alignment. It can treat various types of strabismus, such as esotropia (inward turning of the eye) or exotropia (outward turning of the eye).
• Recession : It refers to a procedure that involves the recession (weakening) of the lateral rectus muscle to correct exotropia (outward deviation of the eye). During the procedure, the surgeon separates the eye muscle from its actual insertion point and reattaches it farther back on the eye's surface. This effectively weakens the action of the muscle, allowing the opposite muscle to have more effect on the eye's movement, which can help align the eyes correctly. Recession surgery offers benefits like improved eye coordination and reduced double vision.
• Resection/plication: Resection is a conventional muscle-tightening procedure in squint operation in which the muscle is disinserted and shortened. In a resection procedure, the eye muscle is cut from its site of attachment; a small part of the muscle is removed, and then the shortened muscle is reattached to its initial placement. This can help correct eye misalignment, specifically in cases of esotropia (inward deviation of the eye). Plication is a technique where the surgeon folds or collects the muscle tissue without actually removing a section of the muscle. This effectively shortens the muscle's length by folding it upon itself and suturing it in place.
• Adjustable suture strabismus surgery: With adjustable suture eye surgery, your eye surgeon alters sutures holding eye muscles in place after a resection procedure to attempt to enhance the final result. This surgery is probably best for individuals in whom squint developed in adulthood after previously normal eye alignment. In this procedure, the eye is patched, and about 4 to 24 hours later, the patch is removed when anesthesia and sedation have faded. Ocular alignment is then evaluated by the eye surgeon. Based on how the eyes are aligned, the surgeon may choose to use the suture that is in place to loosen or tighten the treated muscle. This adjustment may result in slight discomfort, especially with muscle tightening. Once the desired alignment is attained, the surgeon ties the adjustable suture permanently in place, and the procedure is complete.
• Scleral buckling: This procedure is used for certain types of squint associated with retinal detachments. Scleral buckling surgery is a common way to treat retinal detachment. It is a technique of closing breaks and flattening the retina. A scleral buckle is part of a silicone sponge or semi-hard plastic that your ophthalmologist positions on the outside of the eye (the white part of the eye). This material is sewn to the eye to keep it in place, and the buckling element is usually left in place permanently. The element moves the sclera toward the middle of the eye and relieves the pull on the retina, letting the retinal tear settle against the eye wall. Generally, extreme cold (cryopexy), light (laser photocoagulation), or heat (diathermy) is used to scar the retina and keep it in place until a seal appears between the retina and the layer beneath it.

During squint surgery, your ophthalmologist or eye surgeon will perform a series of carefully planned steps to correct the misalignment of the eyes. The surgical procedure seeks to adjust the eye muscles to achieve proper alignment and enhance the coordination of eye movements. Here's an overview of what generally happens during squint operation:

• Evaluation : Before squint surgery, an ophthalmologist or eye surgeon will evaluate the patient's condition to determine the degree of misalignment and its cause.
• Anesthesia : Squint surgery is typically performed under local anesthesia, which numbs the eye and the surrounding region. In some circumstances, particularly for young children or people who may have problems staying still, general anesthesia may be utilized to ensure the patient remains comfortable and static during the procedure.
• Incision : The surgeon will make tiny incisions on the eye's surface to access the eye muscles. The area of the incision may vary based on factors such as the type of squint and the specific muscles being targeted.
• Muscle adjustment: The surgeon carefully identifies the eye muscles accountable for the misalignment and makes precise adjustments to these muscles. The objective is to attain proper alignment of the eyes in both primary gaze (looking straight ahead) and different directions of gaze. The ophthalmologist may tighten, loosen, or reposition the muscles as required to achieve the desired alignment.
• Sutures : Sutures are then used to secure the adjusted muscles in their new positions. These sutures are generally absorbable and do not need to be removed. The eye surgeon may use different techniques to change the length or tension of the muscles, ensuring that the eyes are correctly aligned.
• Postoperative care: After the surgery, the patient is usually observed briefly to ensure no immediate complications. The eyes may be covered with a protective shield, and eye drops or ointments may be prescribed by the surgeon to prevent infection and help in healing. Pain relief medicines may also be provided if required.

Squint eye surgery can offer various benefits, including:

• Better alignment of the eyes : The primary objective of squint surgery is to realign the eyes, which can enhance one's overall facial symmetry.
• Enhanced vision: Strabismus can lead to double vision and reduced depth perception. Surgery can help restore normal binocular vision, improving the ability to focus on objects and see them clearly.
• Improvement of an abnormal head position: Squint eye operation can also help improve an unusual tilt or turn of the head (abnormal head posture).
• Self-esteem and confidence: Correcting a squint can elevate self-esteem and confidence, as it often eliminates the self-consciousness associated with an eye misalignment.
• Elimination of diplopia: Squint surgery can help eliminate diplopia (double vision) by realigning the misaligned eyes. Diplopia occurs when the eyes are not correctly aligned, causing them to concentrate on different points and resulting in double vision.
• Preventing amblyopia: In some cases, squint eye treatment is performed in childhood to prevent or treat amblyopia (lazy eye), which can lead to long-term vision issues if left untreated.

Here are some key ways to prepare:

• Schedule an appointment with an ophthalmologist or eye expert who can assess your condition and determine if surgery is required.
• Provide your complete medical history, including any underlying health conditions and medicines you're taking.
• Do not use Vitamin E or C supplements or other herbal remedies for two weeks before surgery.
• Do not eat or drink anything after midnight on the day before surgery.
• Do not wear eye makeup on the morning of surgery.
• You may undergo a series of eye tests, such as refraction tests, to determine the extent of the squint and the best approach for surgery.
• Have an open and candid discussion with your eye surgeon about your goals, expectations, and any concerns or questions you may have regarding the surgery and its outcomes.
• Discuss the type of anesthesia to be used with your surgeon. In squint surgery, local anesthesia is often preferred, but there may be variations depending on the procedure and your comfort.
• Follow any specific instructions provided by your ophthalmologist regarding preoperative care. This may include stopping certain medicines or adjusting their dosages. If you are prescribed any eye drops or medicines, use them as directed.
• Since you may not be able to drive immediately after the surgery, arrange for someone to drive you home.
• Bring any essential documents, insurance information, identification, and a list of current medicines to the surgical facility.
• Dress comfortably in clothing that's easy to change, as you may need to wear a surgical gown.
• Arrange for someone to help you during the initial healing period, as you might experience temporary vision changes and discomfort.
• Follow guidelines for maintaining proper hygiene, including washing your face and eyes before your surgery.
• Schedule any necessary follow-up appointments with your eye surgeon to observe your progress.
• Be mentally prepared for the surgery and the healing process. Understanding what to expect can help minimize anxiety.

Remember that the specific preparations can differ based on the type of squint eye surgery and your individual health requirements. Always consult with your eye surgeon, follow their guidance, and address any concerns or questions you may have before the surgery.

After squint surgery, it's essential to follow your ophthalmologist's post operative instructions for a successful recovery. Here are some general tips to follow after squint eye surgery:

• Follow the medication schedule given by your ophthalmologist, which may include eye drops or lotions to prevent infection and reduce inflammation.
• You might be asked to wear an eye patch or protective shield to cover the operated eye from external factors.
• Plan to take it easy for the first few days following squint surgery. Take rest and avoid strenuous activities that could strain the eyes.
• Abstain from rubbing or touching the operated eye to avoid disrupting the recovery process.
• Wear sunglasses when going outside to shield your eyes from sunlight and dust.
• Keep your hands and the area around your eyes clean. Follow hygiene-specific guidelines provided by your eye surgeon.
• Avoid getting water directly into the eye.
• You can slowly resume light activities, such as reading or watching television, but continue to avoid activities that could strain the eyes.
• Your ophthalmologist may suggest specific eye exercises or vision therapy to help improve coordination and alignment between the eyes. Ensure to follow the recommendations diligently.
• Attend all scheduled follow-up appointments with your ophthalmologist to watch your progress and make any necessary adjustments.
• If you experience increased pain, redness, or any unexpected changes in vision, contact your ophthalmologist immediately.

Remember that recovery times can vary depending on the type of squint surgery and individual factors, so it's important to follow your doctor's specific recommendations for the best result.

While squint eye surgery is generally safe, there are risks and complications to be aware of, including the following:

• Lost muscle: A lost muscle occurs when the extraocular muscle slips free of the surgical tools or sutures during squint surgery. There is no direct attachment between the muscle tendon and the globe, allowing the muscle and its capsule to both retract posteriorly into the orbit. This leads to an emergency situation, and immediate surgical attempts are required to recover the muscle.
• Scleral perforation : Scleral perforation refers to the penetration of the eyeball's outer coat with a surgical needle. In children it often requires no treatment. A scleral perforation in an adult is generally treated by using a freezing probe at the perforation site to minimize the risk of developing a retinal detachment. Antibiotics may also be prescribed to reduce the risk of an infection developing in the eye.
• Post-operative infection: Post-operative infection can occur if the sterile technique is violated or if the patient has a pre-existing medical condition, like nasolacrimal stenosis or blepharitis, increasing the surgical area's bacteria count. Most infections appear around the initial surgical incision into the conjunctiva and present within the first week after surgery.
• Allergic reaction : Allergic reactions can occur sporadically in patients sensitive to the materials or medicines used in the pre-operative period. The risk of an allergic reaction increases in patients with a history of hypersensitivity reactions, systemic allergies, or asthma. The risk of an allergic reaction may be minimized by carefully examining the patient's medical history and avoiding medicines that might cross-react with known medication allergies.
• Overcorrection or under-correction: Sometimes, the surgery may not attain the desired degree of eye alignment, leading to either overcorrection (the eyes turn too far in the opposite direction) or under-correction (the eyes are still misaligned).
• Double vision: Double vision is one of squint eye surgery's most prevalent adverse effects. This happens because the brain needs time to acclimate to the altered eye alignment. During recovery, the brain may experience two independent pictures rather than a single merged vision. However, this effect is usually temporary and resolves as the brain acclimates to the new visual information.
• Foreign body granuloma / pyogenic granuloma: A foreign body granuloma can grow sporadically in susceptible patients, usually a few weeks after squint eye treatment. Pyogenic granuloma, also known as lobular capillary hemangioma, occurs with the proliferation of capillaries with edema (when fluid builds up in the macula, causing inflammation), generally at the conjunctival incision.
• Scarring : Surgical scarring can impact the movement of the eye muscles, leading to persistent misalignment.
• Anesthesia risks: Like any surgical procedure, there are risks associated with anesthesia, including allergic reactions or complications.
• Chronic misalignment: Despite the surgery, some individuals may have chronic eye misalignment. This might be due to several circumstances, including scar tissue production or an underlying medical issue. Resolving chronic misalignment may necessitate further therapy, including additional surgery or alternate treatments.
• Loss of vision: In extremely rare cases, there is a risk of vision loss, especially if complications occur during surgery.
• Conjunctival inclusion cyst: A conjunctival inclusion cyst can occur when conjunctival epithelial cells get buried beneath the conjunctival surface during a squint eye procedure. These cells can reproduce over time to create a subconjunctival cyst after the original surgery. The risk of a conjunctival inclusion cyst increases when the conjunctival wound is not closed meticulously by your eye surgeon.
• Recurrence : In some cases, the misalignment may recur over time, requiring additional surgery.

It's important to discuss these risks with your ophthalmologist or eye surgeon and have a comprehensive pre-surgery evaluation to evaluate your individual case and potential complications. The advantages of squint surgery often outweigh the risks, but it's essential to make an informed decision and follow post-operative care instructions to minimize these risks.

If left untreated, a squint can cause several problems, including:

• Double vision : Untreated squint often leads to double vision, where the eyes do not work together properly, resulting in two separate images. This can be uncomfortable and disrupt day-to-day activities.
• Depth perception issues: One's ability to perceive depth often gets affected by a squint. If squint is left untreated, it will make tasks such as driving or playing sports more challenging.
• Amblyopia (lazy eye) : If the brain begins to prefer one eye over the other due to the misalignment of the eyes, the other eye may become underused and not develop properly, leading to vision issues.
• Blurry vision: Untreated squint can make your vision foggy, and you may develop symptoms such as dry eyes and irritation.
• Social and psychological impact : Strabismus can affect a person's self-esteem and confidence, potentially leading to social and psychological challenges due to the visible misalignment of the eyes.
• Strain and fatigue: Squinting eyes often work harder to maintain alignment, leading to eye strain, fatigue, and discomfort.
• Headaches : Squint may result in headaches due to the extra effort needed to align the eyes correctly.

It's vital to note that early intervention and treatment, such as corrective eyeglasses, vision therapy, or squint eye surgery, can often effectively address squint and its associated problems, minimizing or preventing these potential consequences. If you or someone you know has a squint, it's advisable to consult with an ophthalmologist or eye specialist to determine the best course of action.

When discussing squint eye treatment with your healthcare provider, asking questions is essential to fully understand the procedure and make an informed decision. Here are some questions you can ask your healthcare provider:

• What type of squint surgery is being recommended?
• What are the potential benefits of the surgery?
• What are the expected outcomes in terms of eye alignment and vision improvement?
• Are there any non-surgical options that should be considered before opting for surgery?
• What is the expected duration of the surgery, and will I need to stay in the hospital afterward?
• What type of anesthesia will be used for the surgery, and what are the associated risks?
• How long is the recovery period?
• Does my health insurance cover squint surgery, and if so, what are the necessary steps to ensure coverage?
• How soon after the surgery will I be able to resume normal daily activities, such as work or school?

Typically, the average squint eye surgery cost in India near Rs.45000. However, the surgery cost in India can vary widely based on several factors. Here are some of the key factors that can affect the cost of surgery:

• Type of squint: The specific type of squint, whether it's esotropia (inward deviation), exotropia (outward deviation), hypertropia (upward deviation), or hypotropia (downward deviation), plays a huge role in determining the complexity of the surgery. Different types of squint need different surgical approaches, leading to potential cost variations.
• Hospital or clinic: The choice of hospital or clinic plays a significant role in determining the cost of squint eye surgery in India. Premium or specialized facilities may charge more in comparison to general hospitals.
• Technique for alignment: The method used for aligning the eyes, such as resection (shortening of the muscle), recession (lengthening of the muscle), or plication (folding of the muscle), can affect the surgical procedure's intricacy and time. These variations can affect the overall cost of squint eye treatment.
• Number of muscles corrected: If numerous eye muscles need correction to attain proper alignment, the procedure may need more time, skill, and resources, potentially leading to higher costs.
• Eye surgeon's expertise: The experience and reputation of the surgeon performing the procedure can impact the squint eye surgery cost in India. Highly skilled and experienced surgeons often charge higher fees.
• Location of the hospital or clinic: The cost of medical procedures can vary across different cities and regions in India. Major metropolitan regions may have higher prices compared to smaller towns.
• Diagnostic tests and evaluations: Pre-operative tests, evaluations, and imaging are essential to evaluate the eye's condition and plan the surgery. These diagnostic procedures contribute to the overall cost of squint eye surgery.
• Anesthesia : The type of anesthesia used (local or general) can affect the squint eye surgery cost in India, with general anesthesia generally being more costly.
• Duration of hospital stay: If the surgery needs an extended hospital stay, it can add to the overall squint surgery cost.
• Post-operative care: The overall cost of surgery may include postoperative follow-up appointments, medications, and any necessary vision therapy.
• Insurance coverage : If you have health insurance, it may cover a portion of the squint surgery cost, reducing your out-of-pocket expenses.
• Revision surgery : In some cases, a second or revision squint operation may be required, which can incur additional expenses.

It's important to discuss the squint surgery cost with your healthcare provider and obtain a detailed estimate that breaks down all associated expenses. This will help you make an informed decision and understand the financial aspects of the procedure.