Will the child's strabismus go away after surgery? Severe complications of strabismus surgery. Principles and types of surgery to eliminate strabismus

All materials on the site were prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative in nature and are not applicable without consulting a doctor.

Strabismus or strabismus is a shift in the focus of one or both eyes and a resulting disturbance in binocular vision. The disease can be caused by various factors. Sometimes it is congenital, sometimes there is only a predisposition, and strabismus occurs as a result of infection or stress.

There are several methods of treating the disease - wearing special glasses, “temporarily” turning off the healthy eye, surgery. Squint surgery involves correcting the position of the eye: weak muscles are strengthened and fibers that are too short are lengthened.

Indications for surgery

Surgical intervention is most effective in childhood. If it is acquired, the optimal age is 4-6 years. In congenital forms of strabismus, the operation is performed somewhat earlier - at 2-3 years. In adults, it can be performed at any age in the absence of general contraindications.

The patient’s desire to eliminate a cosmetic defect in himself or his child.
The entire arsenal of conservative methods was used, but the achieved improvement in binocular vision was not maximum.
The doctor believes that it is advisable to create conditions for restoring vision through surgery. That is, surgery is prescribed first, and then additional correction using conservative methods. This appointment is possible in case of too severe strabismus.

Carrying out the operation

Types of surgery

There are several fundamentally different types of surgical intervention, which are often combined in one operation:

Principles of surgery

The most optimal is the following scheme:

Step-by-step correction. First, the operation is performed on one eye, and after 3-6 months - on the other.
Calculation of muscle shortening or lengthening is carried out in accordance with standard schemes.
Shortening and lengthening should occur evenly on both sides, i.e., for example, when the size of the muscles on the right is reduced, on the left they increase by the same amount.
It is advisable to maintain the connection between the muscle and the eyeball.
In cases of severe strabismus, surgery on more than two muscles is not recommended.

Details of the procedure are determined by the surgeon. With a slight mowing angle, it is possible to correct two eyes at once.

It is worth noting that the approach of Western doctors is somewhat different. Israeli and German specialists approach correction more radically, which makes it possible to correct vision immediately and in one visit. Also abroad, operations to eliminate strabismus are performed before the age of one year. This, according to doctors, helps avoid vision loss and the appearance of amblyopia (a symptom of a “lazy” eye).

Progress of the operation

Surgery is performed under general anesthesia in children and local anesthesia in adults. Sometimes before and after surgery, apparatus exercises (orthoptic exercises on the synoptophore) are indicated. They last 1-2 weeks and are designed to “teach” the eye to see correctly. Sometimes preparation lasts much longer – up to six months. During this period, the doctor recommends taking turns closing and opening the right and left eyes. This is necessary for the formation of stable nerve connections in the brain.

After the onset of anesthesia, the eye is fixed, the eyelids are retracted using special spacers. There are at least two people in the office - a doctor and a nurse. A sterile oilcloth with a slit for the eye is placed on the person’s face. The doctor cuts the sclera, conjunctiva and opens access to the muscles. The nurse periodically moistens the eye and holds it in the correct position.

The muscle is pulled out through the incision. The nurse periodically dabs the eye with a swab so that blood does not interfere with the operation. The doctor makes an incision or suturing of the muscle, taking measurements and monitoring the accuracy of his actions. After this, stitches are applied. In some cases, the operation is performed under a microscope.

At the end of the operation, a bandage may be applied to the eye, which is removed the next day. The patient remains on a drip for some time. Once the anesthesia wears off, he can leave the operating room. As a rule, hospitalization is not required, and the patient returns home on the day of the procedure.

Postoperative period

After the anesthesia wears off, the eye may hurt, and its movements will lead to increased discomfort. It will appear reddened and there may be temporary slight blurring of vision. Adults sometimes experience double vision.

Recovery lasts up to 4 weeks. In children it occurs faster. During this period, it is necessary to periodically visit an ophthalmologist, instill prescribed medications, and perform special exercises. The doctor will give a recommendation for wearing glasses. He usually advises covering the healthy eye in order to quickly “activate” the operated one.

Possible complications

The most serious consequence of the operation is accidental damage to the vagus nerve. It is responsible for the functioning of the muscles of the heart, gastrointestinal tract and lungs. In rare cases, disruption of the innervation can lead to death.

The most common complication is overcorrection– excessive suturing or lengthening of the muscle. It can occur as a result of an error in calculations, a surgeon’s error, or due to the growth of the patient and the natural increase in size of the eye. The optimal prevention of the occurrence of such a symptom is the application of adjustable sutures, not cutting, but suturing the muscle folds. This makes it easy to correct the situation in a minimally invasive way.

Sometimes after resection or cutting off of a muscle and its subsequent suturing, rough scars form. They deprive it of elasticity and mobility. This occurs due to the fact that muscle tissue is partially replaced by fibrous tissue. To prevent such complications, specialists are currently actively developing new methods of accessing the muscle, alternative methods of surgical treatment to reduce the area of the truncated area.

Defects of the eyeball may form as a result of careless actions of the surgeon. They are usually cosmetic in nature and do not affect visual acuity.

Relapse of the disease is the re-development of strabismus. This complication often occurs if the patient neglects the doctor’s recommendations, refuses to wear glasses or perform special exercises. In childhood, relapse can occur with a sharp increase in eye strain, for example, when a child begins to attend school.

Cost of the operation

When contacting a public medical institution, surgery to correct strabismus is performed free of charge, for both adults and children with a compulsory medical insurance policy. Treatment is carried out inpatiently. Some private clinics also work with compulsory health insurance policies.

Children under 18 years of age and those with severe visual impairments may require an accompanying person. His stay in the hospital is not always provided for or may require additional payment.

The average cost of strabismus treatment in private clinics in Russia is 20,000 rubles. The price is influenced by the technology used, the complexity of the operation, and the reputation of the clinic or specific surgeon.

If the choice falls on correcting strabismus in an Israeli or German clinic, you will have to prepare from 7,000 euros. When using an intermediary company, the price may increase 2-3 times.

Surgery to correct strabismus is often the only effective way to treat it. Strabismus is a disorder of binocular vision in which, when looking straight ahead, the position of one or both eyes may have different deviations to the sides.
Double vision after strabismus surgery, healthy eyes
The essence of the operation to correct strabismus

Surgery to correct strabismus is often the only effective way to treat it. Strabismus is a disorder of binocular vision. in which, while looking straight, the position of one or both eyes may have various deviations to the sides. You can consider in more detail the types of operations performed for strabismus, the general provisions for their implementation, possible consequences and results.

Types of surgical intervention for strabismus
The main task of any surgical intervention for strabismus should be considered to be the restoration of the correct balance between the eye muscles responsible for the movement of the eyeball.
There are 2 types of operations for strabismus:

During augmentation surgery, the eye muscle is shortened due to:

Excision of some portion of it (resection);
formation of a special fold at the site of the tendon (tenorrhaphy);
moving the attachment point of the muscle to the eyeball (anteposition).

Relieving surgery to correct strabismus aims to relieve excess tension and weaken the eye muscle by:

Changes in its place of attachment to the eyeball (recession);
its extension (plastic);
excision of part of the muscle fibers (partial myotomy).

Surgical intervention, depending on the situation, can be performed on one or simultaneously on both eyes; any combination of the above types can be used. In some cases, repeat surgery is required.
The issue of surgical intervention is decided by an ophthalmologist after he has established the causes of the specified visual impairment and carried out a complete diagnosis of the eyes. The following factors may serve as indications for surgery to eliminate strabismus:

Ineffectiveness of non-surgical treatment carried out over a long period of time;
very strong degree of strabismus;
paralytic strabismus;
non-accommodative strabismus.

It is important to remember that from a cosmetic point of view, these operations can completely eliminate strabismus, but binocular vision is not always restored.
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General provisions when performing operations for strabismus
The general scheme of surgical intervention is as follows:

Preoperative preparation;
the actual operation;
postoperative recovery.

Each of these periods is of great importance for the favorable outcome of the operation.
Preoperative preparation can last up to 1 year. Its goal is to rid the brain of the habit of perceiving an incorrect image. For this purpose, various electrical stimulation techniques can be used, which are prescribed by the doctor depending on the individual characteristics of each patient.
The operation itself involves highly technical manipulations by a competent ophthalmologist to establish the correct balance between the patient's eye muscles in order to restore symmetry in the placement of the eyes.

The operation is performed using painkillers.
Postoperative recovery can take a different period of time in different patients. It consists of strict adherence to all recommendations of the attending physician for the elimination of:

Redness of the eyes;
discomfort and pain with sudden movements, in bright lighting;
eye discharge;
double vision, etc.

It is important to understand that to eliminate strabismus, the operation must be performed at a strictly defined time, determined by the doctor.

You can't put it off, because... The level of vision may significantly decrease. We must not allow events to be forced, which would have a negative impact on its outcome. In some cases, surgery consists of several necessary steps.

After surgical removal of strabismus, various complications may arise, the elimination of which will require additional eye treatment or repeated surgery. The main complications of this kind should be considered:

Overcorrection of vision;
various inflammatory processes in the operated areas.

The cosmetic effect after a correctly performed operation to correct strabismus will be visible immediately, vision restoration will occur in 1-2 weeks. In some cases, orthoptodiploptic and pleoptic therapies will be required to restore the binocular functions of the eyes and depth vision.
Thus, surgery to eliminate strabismus in most cases can restore normal vision and correct a cosmetic eye defect, thereby returning the patient to a full life.

Often, strabismus surgery does not immediately return normal vision. Many will agree that it is a pity to look at a young, pretty girl or child looking askance. Without this cosmetic defect everything would be fine. In addition, ophthalmologists recommend trying conservative methods of treating strabismus before going under the knife.

What is strabismus, or strabismus?

Strabismus is a pathology in which one, both, or alternately the right and left eyes deviate from the normal position when looking straight. When a person looks at an object, the information received by each eye is slightly different, but the visual analyzer in the cortical part of the brain brings everything together. With strabismus, the pictures are very different, so the brain ignores the frame from the squinting eye. The long-term existence of strabismus leads to amblyopia - a reversible functional decrease in vision, when one eye is practically (or completely) not involved in the visual process.

Strabismus can be congenital or acquired. Newborns often have a floating or sideways gaze, especially after a difficult birth. Treatment by a neurologist can remove or alleviate the manifestations of birth trauma. Another cause may be a developmental abnormality or improper attachment of the extraocular muscles (see Fig. 1).

Acquired strabismus occurs as a result of:

infectious disease: influenza, measles, scarlet fever, diphtheria, etc.;

somatic diseases;

injuries;

a sharp drop in vision in one eye;

myopia, farsightedness, high and moderate astigmatism;

stress or severe fear;

paresis or paralysis;

diseases of the central nervous system.

How can you get rid of strabismus?

Strabismus corrects:

wearing special glasses;

a series of eye exercises;

wearing a blindfold covering one eye;

surgery to correct strabismus.

Variable strabismus, when sometimes the right or left eye squints, is tried to be corrected by wearing a bandage. Long-term use of specially designed glasses often helps. Exercises to strengthen the ability to focus are recommended for almost all patients with strabismus. If all of the above methods do not correct vision, surgery is performed to correct strabismus. This type of surgery is performed both in infancy and in adulthood.

Types of surgeries to correct strabismus

The following types of strabismus occur in children and adults:

horizontal - converging and diverging relative to the bridge of the nose;

vertical;

combination of two types.

Doctors encounter convergent strabismus more often than divergent strabismus. Along with converging strabismus, the patient may have farsightedness. Myopic people usually have divergent strabismus.

During the operation the following can be performed:

amplification type surgery;

debilitating surgery.

In weakening surgery, the eye muscles are transplanted a little further from the cornea, which tilts the eyeball in the opposite direction.

During augmentation surgery, a small piece of the eye muscle is removed, causing it to shorten. This muscle is then sutured to the same place. Surgery to correct strabismus involves shortening and weakening the target muscles, which restores balance to the eyeball. The operation is performed on one or both eyes. The microsurgeon determines the type of surgical intervention when the patient is in a completely relaxed state on the operating table.

In some clinics, the operation is performed under local anesthesia only for adults. and in others, all patients are given general anesthesia. Depending on age, health status and other factors, mask (laryngeal), endotracheal anesthesia using muscle relaxants, or an alternative type of anesthesia is performed.

It is important that during surgery the eyeball is motionless and there is no tone in the muscles, because the surgeon conducts a special test: he evaluates the degree of restriction of eye movements by moving it in different directions.

After surgery, an adult can go home on the same day. The child needs preliminary hospitalization. Most often, mothers are in the hospital with their children; discharge occurs the next day after the operation. The recovery period takes about 14 days. After discharge, the patient extends the sick leave or certificate at his clinic.

It should be noted that in 10-15% of cases, strabismus is not completely eliminated and repeated surgery may be necessary. Surgery using adjustable sutures helps reduce the failure rate. After the patient wakes up, the doctor checks the condition of the eyes after some time under local anesthesia. If there are deviations, he slightly tightens the suture knots and only then finally secures them. All types of operations are performed with completely absorbable suture material.

Adults who have lived for a significant period of time with strabismus sometimes experience double vision after surgery because the brain is unaccustomed to perceiving a binocular image. If before the operation the doctor has determined that there is a high probability of developing double vision, the correction of strabismus is done in two stages so that the brain can gradually adapt.

Carrying out the operation

A few days before surgery, you need to take blood tests, do an ECG and undergo a consultation with some specialists. You should not eat 8 hours before surgery. If it is scheduled for the morning, you can have dinner, and if it is in the afternoon, then a light breakfast is allowed. The child and mother are admitted to the hospital a couple of days before the operation. The procedure is performed under general anesthesia. The operation itself lasts 30-40 minutes, then the patient is taken out of anesthesia and transferred to the ward. All this time, a bandage is placed on the eye. After the operated patient has completely recovered from anesthesia, he is examined by a surgeon in the afternoon. He opens the bandage, checks the eye, puts in special drops and closes it again. After this, adults are sent home with detailed recommendations: what medications to take, what to put in their eyes, and when to come for a second examination. The eye patch is left until the next morning. After a week, you need to come for an examination, where the doctor will assess the speed of healing and the condition of the eye. The final assessment of eye position is carried out after 2-3 months.

For several weeks after surgery, special anti-inflammatory drops and (if necessary) antihistamines are used. The eye will be red and swollen. Sometimes the next morning the eye will stick together due to accumulated pus. There is no need to be scared: it is washed with warm boiled water or sterile saline solution. For a couple of days the eyes will be very watery and sore, and it will also seem as if there are specks in the eye. The sutures dissolve on their own after 6 weeks.

For a month after surgery, you need to carefully protect your eye. You cannot swim, stay in dusty areas or play sports. Children at school are exempted from physical education for six months.

A month after the operation you need to undergo a course of treatment. To restore the binocular ability to see and recognize the correct picture, you need to undergo special hardware treatment at a medical center. Some clinics have the Amblicor complex, developed by specialists from the Brain Institute. Treatment using this device is a computer video training. It helps overcome the skill of suppressing vision in one eye. While watching a cartoon or movie, an EEG of the visual cortex of the brain and readings about eye function are continuously taken from the patient. If a person sees with both eyes, the film continues, and if only with one, it pauses. Thus, the brain is trained to perceive the image from both eyes.

Types of surgical intervention for strabismus

The main task of any surgical intervention for strabismus should be considered to be the restoration of the correct balance between the eye muscles responsible for the movement of the eyeball.

During augmentation surgery, the eye muscle is shortened due to:

formation of a special fold at the site of the tendon (tenorrhaphy);

moving the attachment point of the muscle to the eyeball (anteposition).

Relieving surgery to correct strabismus aims to relieve excess tension and weaken the eye muscle by:

changes in its place of attachment to the eyeball (recession);

its extension (plastic);

ineffectiveness of non-surgical treatment carried out over a long period of time;

very strong degree of strabismus;

non-accommodative strabismus.

Return to contents

Each of these periods is of great importance for the favorable outcome of the operation.

The operation itself involves highly technical manipulations by a competent ophthalmologist to establish the correct balance between the patient's eye muscles in order to restore symmetry in the placement of the eyes. The operation is performed using painkillers.

Postoperative recovery can take a different period of time in different patients. It consists of strict adherence to all recommendations of the attending physician for the elimination of:

eye discharge;

double vision, etc.

It is important to understand that to eliminate strabismus, the operation must be performed at a strictly defined time, determined by the doctor. You can't put it off, because... The level of vision may significantly decrease. We must not allow events to be forced, which would have a negative impact on its outcome. In some cases, surgery consists of several necessary steps.

excessive vision correction;

Strabismus

The ultimate goal of strabismus surgery is to restore symmetrical (or as close to symmetrical) eye position as possible. Such operations, depending on the situation, can be performed both in adults and in children.

Types of surgeries to correct strabismus

In general, there are two types of operations for strabismus. The first type of surgery is aimed at weakening the overly tense extraocular muscle. An example of such operations is recession (crossing a muscle at its insertion and moving it in such a way as to weaken its action), partial myotomy (partial excision of part of the muscle fibers), muscle plastic (for the purpose of lengthening). The second type of surgery is aimed at strengthening the action of the weakened extraocular muscle. An example of operations of the second type is resection (excision of a section of weakened muscle near the attachment site with subsequent fixation of the shortened muscle), tenorrhaphy (shortening of the muscle by forming a fold in the muscle tendon area), anteposition (moving the site of muscle fixation in order to enhance its action).

Often, during surgery to correct strabismus, a combination of the above types of surgical intervention (recession + resection) is used. If, after surgery, there is residual strabismus that is not leveled by self-correction, repeated surgery may be required, which is usually performed after 6 to 8 months.

To achieve maximum effectiveness when performing surgery to correct strabismus, you must adhere to several basic principles.

1. Unnecessarily speeding up the process of surgical correction of strabismus often leads to unsatisfactory results. Therefore, all manipulations should be carried out in doses (if necessary, in several stages).

2. If it is necessary to weaken or strengthen individual muscles, dosed surgical intervention should be distributed evenly.

3. When performing surgery on a specific muscle, it is necessary to maintain its connection with the eyeball.

High-tech strabismus surgery:

Specialists from children's eye clinics have developed modern high-tech radio wave surgery using the principles of mathematical modeling.

Advantages of high-tech eye surgery:

The operations are low-traumatic; thanks to the use of radio waves, the structures of the eye are preserved.
After the operations there is no terrible swelling, the patient is discharged from the hospital the next day.
Operations are precise.
Thanks to the principles of mathematical calculation, we can ensure the highest accuracy and show the guaranteed result of the operation even before it is carried out.
The rehabilitation period is reduced by 5-6 times.

Result of the operation: highly effective strabismus surgery technologies make it possible to ensure a symmetrical gaze position in various types of strabismus, including those with small and unstable angles, and to restore the mobility of the eyeball in paralytic strabismus in 98% of cases. This is a unique way to effectively help the patient.

Results of surgery for strabismus

Surgical treatment of strabismus allows you to correct a cosmetic defect, which is a strong traumatic factor for patients of any age. However, to restore visual functions (i.e., binocular vision) after surgery, an integrated approach is required, which includes pleoptic therapy (it is aimed at treating amblyopia accompanying strabismus) and orthoptodiploptic therapy (restoration of depth vision and binocular functions).

A one-stage operation to correct strabismus in adults can be performed on an outpatient basis; when treating children, hospitalization is necessary in most cases. The approximate recovery time after surgery is 1 week, but to recreate full binocular vision, i.e. The ability to see a three-dimensional image with both eyes at the same time is not enough. During the time that a person had strabismus, the brain, figuratively speaking, “forgot how” to combine images from both eyes into a single image, and it will take quite a long time and significant effort to “teach” the brain this again.

It should be mentioned that, like any operation, surgical correction of strabismus may be accompanied by the development of certain complications. One of the most common complications of strabismus surgery is excessive correction (so-called hypercorrection), caused by errors in calculations. Overcorrection may occur immediately after surgery, or may develop after some time. For example, if the operation was performed in childhood, then in adolescence, when the eye grows, the child may experience strabismus again. This complication is not irreparable and can be easily corrected with surgery.

This surgical intervention is performed in most ophthalmological centers in Moscow and Russia (both commercial and public). When choosing a clinic for an operation to correct strabismus, it is important to study the clinic’s capabilities, living conditions, whether the clinic is equipped with modern equipment and other important points. It is equally important to choose the right doctor to perform the operation. After all, the prognosis of treatment will fully depend on his professionalism.

If you or your relatives have already undergone surgery to correct strabismus, we will be grateful if you leave feedback about the intervention and the clinic where the procedure was performed, as well as the results obtained

The essence of the operation to correct strabismus

General provisions when performing operations for strabismus

There are 2 types of operations for strabismus:

enhancing;
weakening.
excision of some portion of it (resection);
excision of part of the muscle fibers (partial myotomy).

Surgical intervention, depending on the situation, can be performed on one or simultaneously on both eyes; any combination of the above types can be used. In some cases, repeat surgery is required.

The issue of surgical intervention is decided by an ophthalmologist after he has established the causes of the specified visual impairment and carried out a complete diagnosis of the eyes. The following factors may serve as indications for surgery to eliminate strabismus:

paralytic strabismus;

It is important to remember that from a cosmetic point of view, these operations can completely eliminate strabismus, but binocular vision is not always restored.

General provisions when performing operations for strabismus

The general scheme of surgical intervention is as follows:

preoperative preparation;
the actual operation;
postoperative recovery.

Preoperative preparation can last up to 1 year. Its goal is to rid the brain of the habit of perceiving an incorrect image. For this purpose, various electrical stimulation techniques can be used, which are prescribed by the doctor depending on the individual characteristics of each patient.

redness of the eyes;
discomfort and pain with sudden movements, in bright lighting;
various inflammatory processes in the operated areas.

Thus, surgery to eliminate strabismus in most cases can restore normal vision and correct a cosmetic eye defect, thereby returning the patient to a full life.

Treatment of strabismus and its complications

Since strabismus develops against the background of other pathological conditions of the organ of vision, and symptoms are detected when the disease has already developed, then, quite often, regular contact with an ophthalmologist allows you to avoid the occurrence of strabismus itself and the complications accompanying it.

Treatment of strabismus begins from the moment the diagnosis is established and the underlying disease that resulted from it is eliminated. After eliminating the root cause, patients with strabismus undergo complex multi-stage treatment.

Optical correction

At the first stage, the cause of strabismus is determined, and conditions are created for normal visual functioning. If a refractive error is detected, its correction is prescribed with correctly selected glasses or contact lenses, which are selected after many days of cycloplegia using an atropine solution in an age-specific concentration. This procedure is necessary to identify the hidden part of farsightedness or eliminate the false part of myopia created by tension in the ciliary muscle, which is responsible for clear near vision (spasm of accommodation).

Pleoptic treatment of strabismus

Pleoptic treatment of strabismus includes a whole range of measures, the purpose of which is to increase and level the visual acuity of both eyes to the age norm. If functional vision loss (amblyopia) is present or more pronounced in one eye, then occlusion (exclusion from visual work by gluing) is prescribed to the better-seeing eye. With constant strabismus, the occlusion mode is alternating, the worse-seeing eye is sealed for one day, and the better-seeing eye is glued for two or more, depending on the difference in visual acuity. Treatment of amblyopia is a difficult and lengthy process, to accelerate which various types of retinal stimulation are used. At home, these are flash exposures, perifoveal penalization, and training of accommodation reserves. In the conditions of the ophthalmology department, this group of patients can be treated with more effective methods - computer techniques, laser stimulation. electrical stimulation. magnetic stimulation. pattern stimulation, color therapy, in case of incorrect fixation - maculotester, monocular spatial reorientation using Küppers lights on a non-reflex ophthalmoscope.

Preoperative orthoptic treatment

Preoperative orthoptic treatment of strabismus begins after achieving relative equality of vision in both eyes. A symmetrical position of the eyes is possible only if the correct spatial perception of objects by each eye and the creation of a single visual image by the brain by combining the images received from each eye. Surgical correction of strabismus leads to an orthophoric position of the eyeballs in the orbit, but for correct image perception, the patient must have binocular vision before surgery. Firstly, before curing strabismus, alternating occlusion is strictly necessary. This avoids the occurrence of pathological mechanisms in the brain to combat double vision: functional scotoma of suppression and abnormal correspondence of the retina. They start with the simplest thing - creating consistent visual images using Chermak lighting, as well as using special devices. When treating with a synoptophore, visible objects are placed in eyepieces, which are set at an angle equal to the angle of strabismus. Therefore, a patient with strabismus perceives what he sees as a person with an even eye position. During classes on the four-point color test or when fixing a light source through Bagolini glasses, asymmetry of the visual axes is corrected by prisms, prism compensators or elastic Fresnel prisms. At this stage of treatment, the ability to turn on binocular vision is formed when looking sideways, from one object to another, thus developing fusion reserves.

Surgical correction of strabismus

Surgical correction of strabismus is carried out only if the pleopto-orthopto-diploptic treatment of concomitant strabismus is insufficiently effective. Surgical correction of strabismus in children is best performed at the age of 3-4 years, when the child has developed the ability to include binocular vision. Early surgical correction of strabismus in children without preliminary orthoptic exercises is indicated mainly for large angles of eye deviation in congenital strabismus. In adult patients, surgery to correct strabismus can be performed at any time, depending on the patient’s wishes.

Surgery to correct strabismus in paralytic strabismus. In case of paralytic strabismus, the indications and timing of surgical treatment are determined only together with the relevant specialists (neurologist, oncologist, infectious disease specialist).

Surgical correction of strabismus can serve several purposes:

reduction of the strabismus angle before pleoptic or orthoptic treatment,
preventing the development of contracture of the external muscles of the eye with a large amount of strabismus,
for the purpose of functional cure for strabismus,
for cosmetic purposes when it is impossible to improve vision or teach correct binocular vision.

Surgical correction of strabismus is performed by performing two types of operations: strengthening or weakening of the eye muscles. Technically, there are many methods of surgical dosed intervention. In order to weaken the muscle, recession (moving away), partial myotomy (incomplete dissection of the muscle), tenomyoplasty (muscle lengthening) are performed, and to strengthen it, resection (shortening) of the muscle-tendon part and prorrhaphy (moving the muscle anteriorly) are performed.

Classically, with recession (weakening surgery), the attachment site of the muscle changes, it is transplanted further from the cornea; with resection (strengthening surgery), the muscle is shortened by removing part of it, the attachment location of the muscle to the eyeball remains the same. The extent of the operation to correct strabismus is determined by the size of the strabismus angle. The correct position of the eyes can be restored in the vast majority of cases. The remaining eye deviation after surgery can be subsequently eliminated with the help of orthopto-diploptic treatment. When indicated, a combined surgical correction of strabismus is performed, when one muscle is simultaneously weakened and another muscle is strengthened in one and then the other eye.

Postoperative orthoptic treatment

Postoperative treatment of strabismus involves the same principles as preoperative treatment and is aimed at restoring and developing binocular vision.

At this stage, the symmetrical position of the eyes achieved after the operation is consolidated. The child’s ability to see binocularly improves, fusion reserves expand, and physiological double vision is formed, which is necessary for correct perception of the distance to an object.

Treatment of strabismus is a long process that requires a lot of patience from you, strict adherence to the doctor’s recommendations, and an understanding of the stages of treatment. The earlier the pathology is identified and treatment of strabismus is started, the higher the likelihood of your full functional recovery.

Surgical treatment of nystagmus

Surgical treatment of nystagmus involves changing the tone of the horizontal muscles in order to move the position of “relative rest” to the midline position. The operation is performed strictly symmetrically on both eyes and in two stages. At the first stage, bilateral recession of the muscles associated with the slow phase of nystagmus is performed. The second stage of the operation consists of bilateral resection of the muscles responsible for the fast phase of nystagmus. It is advisable to carry out this stage after the result of the first operation is determined and the nystagmus acquires a stable jerky character. If after the first stage of the operation the nystagmus is eliminated or sharply reduced, the second stage is not resorted to.

In conclusion, it must be emphasized that surgical treatment of pathology of the oculomotor system (strabismus, nystagmus) is extremely rarely accompanied by complications, and, as a rule, brings a sense of great satisfaction to both the ophthalmic surgeon and the patient.

The disease is often recognized visually. If the eyes deviate from the axial center, then this phenomenon is called a strabismus manifestation. The disease is caused by incoordination of the eye muscles.

Causes of the disease

Often the cause of the disease is a brain disease, due to head injury, mental disorders or eye surgery. The progression of the disease is facilitated by severe fear, stressful situations or previous infection with influenza, diphtheria, scarlet fever, or measles.

Symptoms of the disease

There are two types of strabismus: concomitant and paralytic.

With the first type, the eye may squint either to the right or to the left, but they deviate approximately equally. Almost always, the disease can be hereditary, manifests itself in childhood and is associated with the structure of the eyes.

In the second type of disease, a slanting of the healthy eye is observed. The diseased visual organ works poorly, as atrophy of the eye muscles is observed, the second one performs the functions of both organs, increasing the angle of deviation due to damage to the motor function of the eyes or dysfunction of the optic nerve.

The disease is divided into convergent, divergent and vertical strabismus. With a convergent view, one of the eyes deviates towards the nose, accompanied by farsightedness. If there is divergent strabismus, one of the eyes deviates towards the temporal region and myopia is observed. If it is vertical, then the eye squints upward or downward.

If the head is tilted or turned, the person squints, or sees double, then this is also a symptom of the disease.

It is better to identify strabismus early and start treating it promptly. This increases the effectiveness of treatment.

With strabismus, the pictures are very different, so the brain ignores the frame from the squinting eye. The long-term existence of strabismus leads to amblyopia - a reversible functional decrease in vision, when one eye is practically (or completely) not involved in the visual process.

Types of strabismus

Surgery to correct strabismus is often the only treatment option.

There are some types of surgeries that are aimed at correcting strabismus. They are strengthening or weakening in nature.

Methods of surgical intervention for enhancing or weakening types of operations are different.

If the operation is for strabismus of the first type, then the muscles of the eye are shortened due to the fact that:

any area is excised (the phenomenon of resection);
a special fold is formed in the tendon (the phenomenon of tenorrhaphy);
muscle attachments to the eye area move (anteposition phenomenon).

When a weakening type of surgery is performed to eliminate strabismus, excess tension and weakening of the eye muscles are relieved, therefore:

the type of attachment to the eyeball area changes (type of recession);
it is increased (type of plastic surgery);
part of the muscle fiber is excised (partial myotomy).

It should be noted that what type of surgical intervention will be performed is determined only during treatment by an ophthalmologist.

patient's age;

angle of strabismus;

In most cases, correction affects several muscle groups at once (especially when it comes to adult patients), and sometimes both eyes require surgical intervention.

If the ophthalmologist decides to combine two methods of surgery, it is often done in stages.

combination of two types.

Doctors encounter convergent strabismus more often than divergent strabismus. Along with converging strabismus, the patient may have farsightedness. Myopic people usually have divergent strabismus.

During the operation the following can be performed:

debilitating surgery.

In weakening surgery, the eye muscles are transplanted a little further from the cornea, which tilts the eyeball in the opposite direction.

Concomitant strabismus manifests itself equally when looking in all directions, it involves both eyes, and both deviate from the norm by the same distance. Concomitant strabismus develops in children much more often than in adults. The most common cause of strabismus in this case is progressive eye diseases.

Surgical treatment of strabismus in children and adults can be carried out in two ways: enhancing and weakening interventions are performed.

With weakening surgical interventions, the attachment site of the extraocular muscle is changed. It is transplanted further from the cornea. In this way, the tension of a strong muscle is weakened (in the direction where the eye is deviated).

Strengthening surgery consists of shortening the muscle by removing (resecting) a certain part of it. The place of attachment to the eyeball does not change. This enhances the action of the weakened opposite muscle. This surgical intervention makes it possible to restore uniform muscle balance by strengthening or weakening one of the extraocular muscles.

The surgeon gives preference to one or another type of surgical intervention directly on the operating table. This is due to many features that need to be taken into account: the angle of strabismus, the location of the muscles in a particular patient, the state of his oculomotor system, age and other individual characteristics. Often, several muscles of the oculomotor system are operated on.

Simultaneous operations, which are performed on the muscles of the same name in both eyes, are preferred for alternating strabismus. If indicated, combined ophthalmological operations are also performed. During which the extraocular muscle of one eye is simultaneously weakened and the muscle of the other eye is strengthened (resected).

horizontal - converging and diverging relative to the bridge of the nose;

vertical;

amplification type surgery;

During augmentation surgery, a small piece of the eye muscle is removed, causing it to shorten. This muscle is then sutured to the same place.

Surgery to correct strabismus involves shortening and weakening the target muscles, which restores balance to the eyeball. The operation is performed on one or both eyes.

The microsurgeon determines the type of surgical intervention when the patient is in a completely relaxed state on the operating table.

Weakening. During this type of surgery, the site to which the muscle is attached is transplanted to a further distance from the cornea. Due to this, the influence of the muscle tissue that deviates the eye from the center of the axis is weakened.
Strengthening. This operation removes strabismus by excision (shortening) of the muscle, while its location remains the same.

patient's age;
features of the location of muscle fibers;
angle of strabismus;
general condition and features of eye movement, etc.

Strabismus in children (diagnosis, treatment methods)

Surgical treatment of strabismus in children is most effective at the age of 4-5 years. In case of congenital strabismus, which is characterized by a significant angle of deviation of the eye from the normal position, the operation can be performed at an earlier age.

However, the best results in restoring bipolar vision are obtained by treatment at an age when the child is able to understand and carry out regular eye exercises during the period of postoperative rehabilitation.

As a rule, surgical treatment for childhood strabismus is performed under general anesthesia. In certain cases, hospitalization is required.

Surgical treatment of strabismus in adults

Most often, surgery for strabismus in adult patients is performed on an outpatient basis “in one day.” Local anesthesia is used. Hospitalization is not required, the patient goes home the same day.

Types of operations for the surgical treatment of strabismus

When surgically correcting strabismus, two types of surgical intervention are used: aimed at weakening or strengthening certain extraocular muscles.

If the cause of eyeball displacement is excessive muscle tension, the following surgical techniques may be used:

recession (cutting off the muscle in the area of attachment and moving it to a point that gives less tension);
partial myotomy (excision of part of the muscle fibers;
plastic surgery of the oculomotor muscle aimed at lengthening it.

In situations where strabismus is a consequence of weakness of the extraocular muscles, intervention is carried out aimed at strengthening them:

resection (shortening the muscle by excision and reconnection);
tenorrhaphy (shortening of a muscle due to the formation of a fold in the area of the associated tendon);
anteposition (cutting off a muscle and attaching it to a new place that provides its strengthening).

Most often, strabismus is caused by impaired tone of several extraocular muscles, some of which are weakened, while others are overstrained. Surgical care in this case is combined, including recession and resection.

The results of an ophthalmological examination provide a complete picture of the nature of the disorders and allow the surgeon to develop an individual treatment plan for strabismus. The operation in most cases combines measures to weaken some muscles and strengthen others.

It is impossible to accurately predict the functioning of the extraocular muscles after surgery. Sometimes there is residual strabismus. If it cannot be corrected by exercise, repeat surgery is recommended. It is performed after 6-8 months, when the residual strabismus has stabilized.

For the most effective surgical treatment of strabismus, it is necessary to follow a number of rules:

There is no need to insist on forced treatment of strabismus when gradual correction is recommended. If necessary, surgery on several oculomotor muscles is divided into two or more operations. The combination of multiple simultaneous excisions can lead to an unsatisfactory result.
If several muscles are corrected simultaneously in one operation, an even combination of weakening and strengthening measures is desirable.
Surgical intervention on the eye muscle should not completely disrupt its connection with the eyeball.

The main symptom of strabismus is the asymmetry of the iris and pupil to the palpebral fissure. With paralytic strabismus, the eye cannot move towards the paralyzed muscle, or this movement is difficult.

To compensate for the squinting eye, a person with paralytic strabismus turns or tilts their head. He has to do this so that the image of the object falls on the retina, and then double vision is not observed.

Treatment of strabismus in adults: symptoms and signs

The main symptom of strabismus is the appearance of the eyes, a visible squint. This is not always a reliable sign; for example, strabismus in children under one year of age is often imaginary.

Imaginary strabismus is associated with the structural features of the palpebral fissures in young children, due to which the orbits turn outward, resulting in the impression of divergent strabismus. True strabismus in children under one year of age can be suspected when one eye is constantly deviated, showing signs of paralytic strabismus, but this may simply be caused by the fact that bright toys are always located only on one side of the crib.

In addition to the visible deviation of the position of one of the eyes, the symptoms of strabismus are a forced position of the head (constant tilt to one side or turn), which compensates for double vision, squinting, headaches and dizziness, as well as unilateral decreased vision.

Diagnosis of strabismus is carried out during a full ophthalmological examination; currently, special computer equipment is used for this. Binocular vision tests are carried out, deviation, refraction and mobility of the eyeballs in all directions are checked. If strabismus is diagnosed, a neurological examination is required.

If the cause of strabismus is an eye disease (myopia, hypermetropia, astigmatism, etc.), it is necessary to treat this disease first. Often, correction of visual acuity and measures taken to eliminate amblyopia are sufficient to correct strabismus, especially strabismus in children, since in childhood the nervous system is extremely susceptible and easily restructured.

In case of failure of conservative methods of correcting strabismus, as well as in some forms that are not subject to conservative correction, surgical treatment of strabismus is used. The type of surgical intervention is determined by the ophthalmologist depending on the nature of the strabismus disease.

The operation itself is usually performed under local anesthesia; only for strabismus in children, general anesthesia is used. As a rule, the patient can be discharged on the day of surgery.

Strabismus, surgery

Treatment methods for strabismus

Correction of strabismus in some cases is possible with therapeutic means, but the most radical and effective method is surgical treatment of strabismus. The choice of method depends on the cause of strabismus, as well as its type.

Due to the risk of developing amblyopia and loss of vision in one eye, which will inevitably lead to deterioration of vision in the second, healthy eye, treatment for strabismus should be started as early as possible.

Optical correction involves wearing special glasses or lenses, gluing a healthy eye, which encourages activity in the impaired eyes, and special exercises that stimulate the proper functioning of “lazy” muscles.

Corrective glasses can be successfully used even in cases of strabismus in children under one year of age. You need to know that non-surgical methods for treating strabismus require persistent, consistent and long-term use, over several months or even years.

When treating strabismus after surgery, it is necessary to consolidate the result, and active measures to train the extraocular muscle are still necessary to prevent or eliminate existing amblyopia. Thus, to eliminate strabismus, surgical intervention alone is not enough; an integrated approach is required. With this approach, strabismus is quite amenable to correction.

It is important that surgical treatment results in a good cosmetic effect. After all, most patients, both children, adolescents and adults, are constantly in a state of stress because of their appearance. The operation eliminates this problem.

Surgical treatment to correct strabismus is carried out under local (drip) anesthesia. Final recovery after such surgery takes about one week, but ophthalmologists strongly recommend undergoing an additional course of hardware treatment.

Experts have proven that a person with normal vision sees a slightly different image with the right and left eyes. You can check this by closing first one and then the other eye.

Normal vision is binocular. And in order for the operated patient to see one image, and not two, just performing the operation is not enough.

This is due to the fact that the brain is not yet accustomed to such work. It is in order to restore physiological binocular vision (when the brain combines two images received by different eyes into one) that constant exercises are required over a long period of time.

Attention! The video contains video footage of a surgical operation.

Only a doctor can determine the appropriate way to get rid of such a problem, depending on individual indicators and the type of strabismus.

Correction with glasses

The most popular and affordable way to get rid of this problem is to select lenses to wear. These can be traditional glasses or contact lenses, the main thing is that they are “prescribed” by a doctor.

The right lenses can even out the focusing angle and also improve communication between the optic nerves.

Exercises

Special eye exercises give good results. It won’t take much time to complete them, so be sure to take these techniques into your arsenal.

Execution algorithm:

Focus your gaze on the index finger of your outstretched hand. Gradually move your hand closer to your nose without looking away. The minimum distance to the eyes is 10 centimeters, it is necessary to repeat 5 - 10 approaches every day.
It is necessary to move your gaze to the right and left as far as possible without turning your head. Repeat movements 5 - 10 times in each direction.
Slowly raise your gaze as high as possible (with your head motionless), then all the way down. The number of repetitions is also from five to ten times.

It is useful to focus your attention on distant objects throughout the day (for example, by looking out the window). After several minutes of looking, you need to look away at objects that are closer. You can repeat such techniques an arbitrary number of times, but this habit has a very positive effect on the quality of vision.

Circular rotation of the eyes in one direction. By repeating these actions, you can synchronize the work of the eye muscles. Regular implementation will help strengthen the eye muscles and align the center of focus. It is advisable to perform each technique in a standing position, increasing the load gradually.

Although the movements are simple, they are very effective, so even your ophthalmologist can recommend your preferred technique.

Hardware treatment

The use of forced focusing of the eye is carried out using special methods. The simplest method is to wear bifocal glasses. Lenses in glasses can also have different degrees of zoom in order to “teach” both eyes to connect the image.

This has a positive effect on the perception of what you see, and causes the visual center in the brain to reconnect the connection between both eyes.

When treating strabismus, special devices and tables are used. It is advisable to agree on the appropriate method with your doctor, because all methods are designed to solve various problems.

Among the most popular are special massagers and devices, as well as computer programs for training and relaxing the eye muscles.

Surgical intervention

A feature of strabismus that appears in adulthood is the impossibility of rapid adaptation of the brain. The image may double, and there is also a sharp deterioration in the visual function of one eye.

In this case, it is necessary to act immediately, and conservative treatment may not give the desired result.

Surgical intervention is classified:

Traditional surgery is now most often not used due to trauma and long rehabilitation. This weakens or strengthens the eye muscle of the damaged eye. The type of manipulation is selected depending on the existing problem. The cost of such a procedure varies from 45 thousand rubles per eye.
Laser correction of strabismus. This is a more gentle method, the type and degree of intervention of which is determined individually. There are several types of laser equipment, and the cost of such an intervention will be slightly more expensive - from 60 thousand rubles per eye.

By correcting the position of the muscle, you can count on a positive result, but with severe strabismus, several such operations may be necessary.

At home

The effectiveness of self-treatment is much lower; in addition, such methods can lead to a worsening of the problem.

It is advisable to use traditional medicine only when prescribed by a doctor; in the early stages it can improve visual function, but with severe strabismus it will not be effective.

Ways to get rid of strabismus using traditional methods:

A decoction of calamus root. It's very easy to prepare. To do this, boil 10 grams of the dry mixture in a glass of water, leave and strain. Use half a glass three times a day before meals.
Decoction of pine needles. Brew dried pine needles in a water bath at the rate of 100 grams per 500 ml of water. Divide the resulting decoction into 4 - 5 servings and take throughout the day.
Dill seed drops. Pour boiling water over the raw materials crushed in a coffee grinder (a tablespoon per glass of water). It is advisable to wrap the mixture and let it brew for two hours. Strain the resulting solution and drop two drops into the eyes three times a day.

To do this, it is useful to combine traditional medicine methods with traditional remedies and drug treatment. An ophthalmologist will help you develop a suitable treatment plan, so you should not risk your eye health by prescribing treatment yourself.

For divergent strabismus

A feature of divergent strabismus is its pronounced symptoms and visual clarity.

Depending on the degree of muscle damage, special gymnastics, wearing glasses with one lens closed (in this case, the load on the affected eye becomes maximum and leads to improved signal perception by nerve fibers), as well as hardware treatment techniques are prescribed.

The prognosis is favorable if the disease is diagnosed at an early stage, so it is better not to delay a visit to the doctor.

For hidden strabismus

Diagnosis of hidden strabismus is possible only by a specialist. The symptoms and visual expression in this case are very mild, but this does not make the problem any easier. You can notice signs of hidden strabismus by observing another person.

As a rule, deviation of one or both eyes from the central axis occurs in a relaxed position, when the gaze is not focused on a specific object. It is not possible to diagnose strabismus on your own, but even a slight deterioration in vision should alert you and force you to see a doctor.

As a rule, treatment for hidden strabismus depends on the degree of damage to the eye muscles. Eye exercises help well, as does moderation when doing work that requires concentration. It is very harmful to look at pictures or read text while moving, so give up such a “bad” habit in transport or on the road.

The goal of surgery on the extraocular muscles for strabismus is to achieve correct eye position and, if possible, restore binocular vision. However, the first step in the treatment of childhood strabismus is the correction of any significant refractive errors and/or amblyopia.

Once the maximum possible visual function has been achieved in both eyes, any residual deviation must be corrected surgically.

There are 3 main types of operations for strabismus: (a) weakening, reducing the traction force, (b) strengthening, increasing the traction force, (c) changing the direction of action of the muscle.

External rectus paralysis

1. Operation Hummelshelm

a) recession of the internal rectus muscle;

b) the lateral halves of the superior and inferior rectus muscles are cut off and sutured to the superior and inferior edges of the paretic lateral rectus muscles

Operation video

redness of the eyes;
discomfort and pain when there is a sudden movement or bright lighting;
ocular secretions;
double vision, etc.

Elimination of the manifestations of strabismus or strabismus occurs within a strictly established time, which is determined by a specialist. You cannot delay or force events because this may have a negative impact on the outcome.

Modern ophthalmic surgery gives very high results in the surgical treatment of strabismus. Only in 10-15% of cases there is a residual slight strabismus.

In this case, it is not entirely correct to say that there is a “complication”, since this mild violation does not affect the quality of life and professional activity. If, as a result of the operation, the strabismus remains significant, a repeat operation is possible.

Treatment of strabismus affects only the extraocular muscles, so surgical procedures do not pose a risk to vision. Re-intervention is recommended if there is significant residual eyeball obliquity.

One of the possible complications after surgical treatment of strabismus may be infection of the surgical field. However, this problem is easily solved with drops containing antibiotics. These drugs can also be prescribed for prophylactic purposes in the first postoperative days.

In the first hours or days after surgery for strabismus, double vision (diplopia) may be observed. If vision does not return to normal within a few days, additional corrective measures may be required. Fortunately, this complication is extremely rare.

Surgical treatment of strabismus gives an immediate visible result - the position of the eyeballs during the visual process becomes correct (symmetrical). However, eliminating a cosmetic problem does not mean complete normalization of visual functions.

Since strabismus leads to significant disturbances in the brain processes of visual perception and image analysis, the patient, as a rule, after surgery will undergo a course of exercises and procedures that help restore binocular vision and three-dimensional perception of the surrounding picture of the world.

The main task of postoperative rehabilitation after surgical treatment of strabismus is to “teach” the visual system to function correctly again. Most often in modern ophthalmology, hardware treatment is used for these purposes.

An individual course of rehabilitation exercises allows you to expand the fusion reserve and re-include the eye in which the movements of the eyeball were impaired in the work of the visual system. The goal of such a course is to achieve an equivalent perception of the pictures formed on the retina of both eyes, and to merge them in the corresponding structures of the brain into a single image.

The Moscow Ophthalmology Center offers patients with strabismus a comprehensive examination and multi-stage treatment, including surgery and rehabilitation, individual programs of conservative care, hardware and physiotherapeutic procedures.

injuries;

a sharp drop in vision in one eye;

myopia, farsightedness, high and moderate astigmatism;

diseases of the central nervous system.

For several weeks after surgery, special anti-inflammatory drops and (if necessary) antihistamines are used. The eye will be red and swollen.

Sometimes the next morning the eye will stick together due to accumulated pus. There is no need to be scared: it is washed with warm boiled water or sterile saline solution.

For a couple of days the eyes will be very watery and sore, and it will also seem as if there are specks in the eye. The sutures dissolve on their own after 6 weeks.

Hello!

Woman, 60 years old, I live abroad, which makes it difficult to communicate with doctors, I don’t understand everything.

On 9/11 there was surgery on the left eye for convergent strabismus.

Initial condition: high degree of myopia since childhood (-12D), a small degree of descending alternating strabismus. In 1980 - scleroplasty with allografts.

In 1990 - tunnel keratoplasty and keratotomy. The result is quite acceptable: left eye - residual myopia -1.5D; right - 4.5D.

The squint remained and over the years became more and more pronounced, severe diplopia. Signs of postoperative corneal dystrophy, initial stage of cataract.

Common diseases: chronic viral hepatitis B resulting in cirrhosis, hypothyroidism.

During the operation, retrobulbar anesthesia with lidocaine was used, plus subcutaneous atropine and eye drops. Everything seemed to go well, although there was severe vomiting after 4 hours and very severe pain in the eye.

They measured the IOP - 27. The next day they opened the eye, there was no diplopia, the eye stood straight, all red, naturally.

Vision is sharply reduced, everything is in a fog, IOP is 21. I was discharged with a prescription.

Voltaren drops 4 r. per day, chlormycetin ointment 4 r.

in a day.

Yesterday I noticed that the sclera of the eye was sharply swollen and raised with red-yellow cushions around the iris. The iris looks as if immersed in these “pillows”.

My vision has improved somewhat, but I still see much worse with this eye than with my right one. (It was the other way around, see

higher). Temperature 37.1.

The pain is much weaker, more like a headache than an eye ache. Lacrimation is profuse, there is yellow liquid discharge.

The type of strabismus, the age of the patient, the method of correction of strabismus and the postoperative period are individual for each person, however, you can read the reviews of patients who have undergone such treatment, or describe your own impressions.

During preoperative preparation, a specialist conducts a sensorimotor examination. It consists of external stimulation of the oculomotor muscles.

Such a diagnostic procedure is necessary in order to determine which muscle structures make the main contribution to strabismus, and which of them need to be affected (weakened, strengthened or moved).

The degree of strabismus is also determined. Thus, the surgeon thoroughly studies the situation and determines the operation plan for himself.

Often both eyes require intervention, although the axis deviation is present on only one side.

Surgery to correct strabismus is rarely associated with massive bleeding. However, as a precaution, your doctor may recommend temporarily stopping taking anticoagulants, antiplatelet agents, or ibuprofen. Standard laboratory and instrumental examinations are also required - general and biochemical blood tests, fluorography or x-rays, electrocardiogram.

On the eve of the intervention, a decision is made on the method of pain relief. Most often in children and adults this is general endotracheal anesthesia. If there are contraindications or the patient is unwilling, retrobulbar injections of local anesthetic in combination with intravenous sedation are used as an alternative.

In the operating room, the patient is in a supine position. The skin of the periorbital area is carefully treated with an iodine-containing antiseptic.

After pre-processing their hands, the surgeon and operating nurse put on sterile gowns and gloves. A sterile napkin with a hole for the surgical field is placed on the face.

All these measures are necessary to prevent infectious complications in the postoperative period.

The early postoperative period involves careful monitoring of the patient and monitoring of his cardiorespiratory parameters. This is especially true after general anesthesia.

The patient or his parents (such operations are often performed on children) receive detailed recommendations for postoperative care. Moderate pain, redness or itching in the area of the operated eye is normal.

The conjunctiva is usually hyperemic and edematous, and there may be a permanent sensation of a foreign body. An increase in volume due to swelling of the upper and lower eyelids is acceptable.

Such symptoms resolve within 2-3 days. For severe pain, it is permissible to take non-steroidal anti-inflammatory drugs (nimesulide, ketorolac) in adults. Children are prescribed paracetamol or ibuprofen in an age-appropriate dosage.

Full recovery usually takes 1-2 weeks. After this time, adults can return to their daily activities and children can go to school. In this case, it is important to take precautions - ensure that the eye does not come into contact with foreign bodies, do not rub it with dirty hands, and also avoid all kinds of injuries to the organ.

There are 3 types of interventions that weaken the action of the muscle: (a) recession, (b) myectomy, (c) posterior fixation sutures.

This is the weakening of a muscle by moving its insertion posteriorly towards the origin of the muscle. Recession can be performed on any muscle except the superior oblique.

1. Recession of the rectus muscle

a) after exposure of the muscle, two absorbable sutures are placed on the outer quarter of the width of the tendon;

b) the tendon is cut off from the sclera, the amount of recession is measured and marked on the sclera with a compass;

c) the stump is sutured to the sclera posterior to the original attachment site

2. Recession of the inferior oblique muscle

a) exposure of the muscle belly is achieved through an inferotemporal arcuate incision;

b) one or two absorbable sutures are placed on the muscle near its insertion;

n) the muscle is cut off, and the stump is sutured to the sclera 2 mm from the temporal edge (the place of attachment of the inferior rectus muscle).

Myectomy

The procedure involves cutting the muscle at its insertion without rejoining it. This technique is most often used to relieve hyperfunction of the inferior oblique muscle. On the rectus muscles, this intervention is performed very rarely with large contracted muscles.

Rear fixation seams

The principle of this intervention (Faden operation) is to reduce the strength of the muscles in the direction of their action without changing the place of attachment. The Faden procedure can be used to treat VDD and also to weaken the horizontal rectus muscles.

When correcting VDD, recession of the superior rectus muscle is usually performed first. The muscle belly is then sutured to the sclera with a non-absorbable suture at a distance of 12 mm posterior to its insertion.

a) after exposure of the muscle, two absorbable sutures are passed through the muscle at marked points posterior to its insertion;

b) part of the muscle anterior to the sutures is excised, and the stump is sutured to the original site of attachment

3. Formation of a muscle or tendon fold is usually used to enhance the action of the superior oblique muscle in congenital fourth cranial nerve palsy.

2. Translation (suturing the muscle closer to the limbus) may provide increased action after previous rectus recession.

Often, strabismus surgery does not immediately return normal vision. Many will agree that it is a pity to look at a young, pretty girl or child looking askance. Without this cosmetic defect everything would be fine. In addition, ophthalmologists recommend trying conservative methods of treating strabismus before going under the knife.

A few days before surgery, you need to take blood tests, do an ECG and undergo a consultation with some specialists. You should not eat 8 hours before surgery.

If it is scheduled for the morning, you can have dinner, and if it is in the afternoon, then a light breakfast is allowed. The child and mother are admitted to the hospital a couple of days before the operation.

The procedure is performed under general anesthesia. The operation itself lasts 30-40 minutes, then the patient is taken out of anesthesia and transferred to the ward.

All this time, a bandage is placed on the eye. After the operated patient has completely recovered from anesthesia, he is examined by a surgeon in the afternoon.

He opens the bandage, checks the eye, puts in special drops and closes it again. After this, adults are sent home with detailed recommendations: what medications to take, what to put in their eyes, and when to come for a second examination. The eye patch is left until the next morning.

After a week, you need to come for an examination, where the doctor will assess the speed of healing and the condition of the eye. The final assessment of eye position is carried out after 2-3 months.

For a month after surgery, you need to carefully protect your eye. You cannot swim, stay in dusty areas or play sports. Children at school are exempted from physical education for six months.

Possible complications

Eye dysfunction can be corrected through surgery. But sometimes various complications can occur, the elimination of which is possible through various health-improving methods or repeated surgical intervention. Complications may manifest themselves:

redundant correction of visual function;
various inflammatory processes in the operated area.

Cosmetic effectiveness is immediately visible if the operation is performed correctly. Vision is restored in one to two weeks, the position of the eyes becomes correct. After the operation, the patient returns to full-fledged activities.

Nowadays, strabismus surgery has become one of the most popular methods of combating this disease. This type of visual impairment is characterized when one or both eyes alternately deviate when looking straight ahead. If the eyes are located symmetrically, then the image of the object in front of the person falls exactly in the center of each eye. Due to this, the picture is combined, and we see three-dimensional objects.

When the eyes look at more than one point, the image begins to double, and the brain has to filter the information transmitted by the squinting eye. If measures are not taken in time, amblyopia may develop, an almost complete functional loss of vision in the eye that is not involved in constructing visual images.

Why do adults develop strabismus?

Strabismus, as doctors call the disease, in adulthood can be a residual manifestation of vision problems that arose in childhood, but acquired ones can also occur. Often doctors cannot determine exactly what caused the development of the disease. These can be either acquired or congenital characteristics of the body:

visual impairments such as farsightedness, myopia, astigmatism;
injuries received;
paralysis;
disturbances in the development and structure of the muscles that move the eyes;
disturbances in the functioning of the central nervous system;
rapid deterioration of vision, affecting only one eye;
consequences of stress or mental trauma;
previously suffered measles, diphtheria or scarlet fever.

What is strabismus?

Strabismus can be acquired or congenital. They also distinguish between permanent and non-permanent strabismus, which appears periodically or completely disappears over time. There are two types of this disease.

When both eyes turn away in turn

With concomitant strabismus, as the name suggests, both eyes are affected. They take turns mowing in approximately the same range. The main cause of this vision pathology is ametropia.

Main distinctive features:

if a person looks at a stationary object, then one eye deviates slightly towards the nose or temple;
at the same time, the deviating eye may change;
mobility of the eyeball is preserved in all directions;
a person does not observe double images before his eyes;
the patient lacks binocular vision;
the primary and secondary angle of deviation of the squinting eye are almost the same;
Deterioration of vision in a squinting eye may occur.

As a rule, a person with concomitant strabismus has other visual impairments: myopia or farsightedness, astigmatism.

When only one eye squints

The second type of pathology is paralytic strabismus. The main difference between this type of visual impairment is that the squinting eye does not move, or moves limitedly in the direction of the affected muscle. The image begins to double, and the person loses the ability to see in volume. The disease is caused by nerve damage, improper functioning of the eye muscles, tumors and injuries.

Signs of this type of pathology include:

where the muscle is affected, the eye does not move;
The primary and secondary deflection angles are different: the secondary one is larger;
double vision, loss of three-dimensional vision;
dizziness;
forced slight deviation of the head towards the affected eye.

All age categories are susceptible to paralytic strabismus: it can develop at any age.

Other types of strabismus

In addition to the above, there are convergent and divergent (exotropia) strabismus, as well as vertical. In the first case, the squinting eye deviates towards the nose. Convergent strabismus is diagnosed more often in children than in adults; during the process of maturation, it often completely disappears. As a rule, the pathology develops against the background of farsightedness.

Divergent strabismus in adults is characterized by the fact that the eye deviates towards the temple. Pathology occurs with congenital or acquired myopia. With vertical - one eye is directed up or down relative to the healthy one.

Treatment of strabismus

Is it possible to correct squint? The answer is yes. Strabismus can be cured. To do this, use special prismatic glasses, or resort to surgical intervention. As the disease progresses, good vision is retained only in the eye that transmits the image to the brain. The squinting eye begins to see worse over time as the brain suppresses its visual functions in order to achieve a stable and clear image. Therefore, it is extremely important to promptly begin treatment of strabismus in adults as soon as the first signs of the disease are noticed.

To achieve results, both individual methods and complexes of procedures can be used:

use of glasses and contact lenses for vision correction;
treatment of amblyopia using hardware methods;
measures aimed at restoring binocular vision;
surgical intervention.

Surgery

Surgery for strabismus is performed for aesthetic purposes to restore the symmetrical position of the eyes. But surgery itself will not restore vision without comprehensive treatment. The surgeon decides on the method of eliminating the problem directly during surgery. It is possible to determine which way to perform the operation only taking into account the location of the eye muscles of a particular patient. In some cases, both eyes are operated on at once. The main goal of the operation is to bring the deviating eye muscle into the desired position and tone.

After surgical correction, there is no need to wear uncomfortable prismatic glasses. This is one of the main reasons why an ophthalmologist refers a patient to a surgeon. Surgery to correct strabismus can improve the quality of life, remove embarrassment due to the negative perception of strabismus, and restore a good emotional state. The cost of the operation is calculated individually in each case.

Is the operation dangerous?

Eye surgery always involves certain risks. When eliminating strabismus surgically, the negative consequence that occurs most often is double image. Usually it goes away after some time, but there are cases when double vision remains. More serious risks include decreased quality of vision, retinal detachment, infections, and problems caused by anesthesia. Fortunately, all of these complications are extremely rare.

An important factor is the general state of health. The better the patient feels, the more successful the operation will be and the faster the eye will recover. In any case, there is no need to worry. The modern level of development of medicine, high-quality equipment and the professionalism of doctors make the likelihood of events developing in a negative way tending to zero.

What results can be achieved with the help of surgery?

Most patients experience significant improvement in vision after surgery. It happens that complete correction of strabismus does not occur immediately, and the body requires a long time to recover after a successfully performed operation. In some cases, repeat surgery may be required. Residual double vision that occurs after surgical procedures is usually eliminated with the help of prismatic glasses.

Patient recovery after surgery: is medical examination necessary?

The first days after surgery, the patient may feel discomfort and headaches, pain when the eye muscles are tense, and a feeling of the presence of a foreign object in the eye. In this case, the doctor prescribes painkillers for him. After just a few days, the unpleasant symptoms go away and the patient can return to active life. However, it is best to avoid heavy exercise for a few more weeks.

Will hospitalization be required after surgery? Depends on the general condition of the patient and the recommendations of his attending physician. Most of the operations are performed on an outpatient basis, and the operated patient returns to normal life within a couple of days.

Postoperative recovery takes, on average, about a week. However, in addition to rehabilitation, a course of hardware treatment may also be required to achieve maximum results and a noticeable improvement in the quality of vision. Vision will be restored over a longer period. Eye exercises and therapeutic procedures will help with this.

Strabismus surgery is available for patients of any age. You can find out how much the operation costs by scheduling a personal consultation with an ophthalmologist. Average prices - from 15,000 rubles to 30,000 rubles per eye. This is a great way to reduce symptoms, correct the aesthetic consequences of strabismus, and simply improve your quality of life. Surgical treatment of strabismus is now considered an effective and safe way to restore vision. Strabismus can be corrected without medical examination and subsequent long-term recovery.