home Adviсe Laser correction of strabismus: types of surgery and results. Where is the best place to have surgery to correct strabismus Surgery to correct strabismus

Laser correction of strabismus: types of surgery and results. Where is the best place to have surgery to correct strabismus Surgery to correct strabismus

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.

Indication 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 can 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.

Many patients and parents of young patients remain dissatisfied with the level of medical care in Russia. Their main complaints are as follows:

Lack of modern equipment, use of outdated techniques, which doctors in other countries have already abandoned.
Lack of an individual approach in the treatment of strabismus.
Delay in the operation, which results in deterioration of vision and progression of the disease.
Insufficient result, incomplete correction of strabismus.
Lack of specialists in this particular profile.

Many parents whose children had surgery in high preschool age in Russia talk about temporary improvement. Performing the exercises, judging by their reviews, gives a good effect, but it is not prolonged. When a child goes to school, he faces increased eye strain. In addition, time is becoming short, parents are trying to pay more attention to their studies rather than their eyesight. Children are also embarrassed to wear glasses in class and take them off when adults do not supervise them. This leads to deterioration of vision and return of strabismus.

Many adults today recall that in childhood it was difficult for them to come to terms with their defect. They experienced ridicule from classmates and neighborhood kids. Some have developed a feeling of their own inferiority, a feeling of self-doubt. This sometimes becomes the reason for turning to a specialist after 18-20 years. Important! However, solving the problem in adulthood gives a lower percentage of successful operations.

Surgery for strabismus can eliminate a cosmetic defect and, in some cases, improve vision. Although this area of surgery is still developing in Russia, there is no need to postpone the operation. If it is not possible to go abroad for treatment, it makes sense to use the services of domestic specialists. After surgery, it is extremely important to follow all doctor’s instructions and visit an ophthalmologist in a timely manner.

Video: strabismus, surgical treatment

Chebykina Ekaterina Gennadievna
Psychologist. Specialist from the site b17.ru
Goncharova Tatyana Anatolyevna
Psychologist, Consultant. Specialist from the site b17.ru
Barakin Andrey Mikhailovich
Psychologist, Ericksonian hypnotherapist hypnosis. Specialist from the site b17.ru
Andronova (Volokhonskaya) Marina Sergeevna
Murzina Svetlana Yurievna
Psychologist, Training Leader. Specialist from the site b17.ru
Sakharchuk Svetlana Alexandrovna
Psychologist, Psychologist - consultant. Specialist from the site b17.ru
Inna Olenina
Psychologist, Art therapist Art coach. Specialist from the site b17.ru
Daria Ivanova
Petrenko Elena Alexandrovna
Psychologist, Gestalt therapist. Specialist from the site b17.ru
Irina Nikolaevna Kuznetsova
Psychologist, Psychoanalyst. Specialist from the site b17.ru

Eye surgery to correct strabismus

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.

Source:

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

Source:

Operation - correction of strabismus

Surgery to correct strabismus is aimed at restoring normal function of the muscles of the eyeball. The causes of such incorrect positioning of the eyeballs are weakening or, conversely, severe muscle tension. During surgical therapy, the doctor strengthens or weakens a certain group of muscles, which leads to a normal central location of the eyeball. Surgical treatment of strabismus is prescribed regardless of age. When such therapy can be carried out, the doctor determines after a complete ophthalmological examination.

Types of surgical intervention

Depending on what needs to be done with the eye muscles, strabismus surgery can be of two types:

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.

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

It takes many factors into account:

patient's age;
features of the location of muscle fibers;
angle of strabismus;
general condition and features of eye movement, etc.
if the doctor has decided that the correction should be gradual, one should not insist on the opposite and rush things;
fully adhere to all post-operative instructions given by the medical staff;
For adult patients, it is advisable to carry out simultaneously weakening and enhancing measures.

the patient’s personal desire to eliminate the pathology;
the futility of using other methods;
serious visual impairment caused by strabismus (including amblyopia).
friendly;
paralytic.

Strabismus can be congenital or may also result from exposure to various factors. And although some consider strabismus only an aesthetic problem, in fact, this pathology can provoke the formation of many unpleasant consequences. It is very important for the patient not only to diagnose the disease in a timely manner, but also to begin solving this problem as early as possible. Squint surgery is a radical and effective method.

Strabismus and its consequences

Strabismus is diagnosed if there are existing deviations in the parallelism of the visual axis of the eyes. More often, the patient has only one eye squinting. In some cases the deviation is symmetrical. There are several types of strabismus and there are also several ways to solve the problem: wearing special glasses, disconnecting one eye organ, surgery.

Important: Most experts are inclined to ensure that surgical intervention is performed in extreme cases. To begin with, it is recommended to try conservative methods of correcting strabismus.

What are the dangers of strabismus? Complete loss of vision of an eye organ that has abnormalities. In this case, the brain stops receiving three-dimensional images, and the images do not correspond to each other. The nervous system gradually blocks data received from the defective eye organ. His muscle tone begins to be lost. The functioning of the eye deteriorates greatly over time and amblyopia develops in 50% of cases.

Reasons for the formation of strabismus

Strabismus can be acquired or congenital. The formation of each of them has its own reasons for its occurrence. Eg.

Acquired type of strabismus

Most often, this type of strabismus develops in children before they reach six months. A significant role in this case is played by existing diseases that provoked such a side effect. But there are frequent episodes of the development of strabismus in the older century category. The most common causes of acquired strabismus are:

strabismus as a result of sharply deteriorated vision with astigmatism, farsightedness, and myopia;
refractive errors of the eye can be caused by developing cataracts or glaucoma, and as a result, strabismus is formed;
paralysis of the eye muscles can cause psychological disorders, as well as somatic diseases (for example: neurosyphilis, encephalitis);
a mild degree of strabismus can be caused by disturbances in blood circulation and sudden surges in pressure, and if the pathology is ignored, disability;
Experts consider childhood diseases such as scarlet fever and measles to be provoking factors for the development of strabismus.

Important: In cases where the child had a predisposition to strabismus, the pathology can manifest itself as a complication after suffering from diphtheria or influenza.

Strabismus can develop in preschool children after severe fright, as well as as a result of psychological trauma. These reasons for the development of pathology were also recorded in older patients. Although in more rare cases.

Congenital type of strabismus

In practice, congenital strabismus is very rare. It is even less common to find it in its pure form, that is, immediately at the birth of the baby. The manifestation of pathology in the first six months of a baby’s life is established as infantile. More often, a newborn has an imaginary strabismus. Children of this age are unable to accurately focus their gaze, and at the same time it seems that the child is developing a pathology.

Interesting: Imaginary strabismus can also be observed in adults when a person is in a state of severe intoxication.

Infantile strabismus often develops due to genetic disorders and during the period when the fetus is still in the womb. This can be caused by the following diseases: cerebral palsy, Crouzon or Down syndrome, as well as hereditary predisposition. In cases of heredity, one of the baby’s relatives also has similar deviations.

At risk are babies whose mothers suffered from infectious diseases during pregnancy, used narcotic drugs, as well as medications without specialist prescription.

Is surgery for strabismus the only solution to the problem?

Surgery to eliminate strabismus is a radical method of solving the problem. Immediately after diagnosis, the specialist will offer conservative treatment methods, which are more gentle methods. These may be special glasses. Their task is to force both eye organs to focus on one point. Over time, the muscles of the damaged eye develop. The pathology is gradually being corrected.

If a patient has one organ affected, an “ocular organ disconnection” procedure may be suggested. For these purposes, a special bandage is placed on the healthy eye. Thus, the brain begins to receive images only from the diseased organ. The muscles gradually develop and the pathology is corrected.

Surgery is recommended in more advanced cases. It cannot guarantee complete restoration of lost vision, but it allows for a more symmetrical relationship between the eye organs. More often, young people agree to the operation, for whom it is very important not to have external defects.

Indications for surgery

The patient used all conservative treatment methods, but no improvements were achieved (or they were not achieved to the maximum extent).
The patient wishes to eliminate cosmetic defects as soon as possible. Conservative treatment can last several months, or even years.
The patient has severe defects. The doctor considered it more expedient to first restore vision through surgery, and only then apply conservative methods to fix or improve the previously obtained result.

Important: The operation can be contraindicated only in cases where the patient has individual characteristics that are previously discussed with his specialist.

There are also some age restrictions. For example, the optimal age for surgical intervention is considered to be 4–5 years old for a child. Younger patients may be turned away. The exception is the congenital form of strabismus, which is corrected at 2–3 years of age. This is explained simply. After surgery, the patient must adhere to a special regime and perform special exercises. Children under 4 years old will not be able to do this consciously and independently. The chances that the pathology will return significantly increase.

Principles and types of surgery to eliminate strabismus

Surgery to correct strabismus is carried out in several types of operations. Sometimes a specialist selects one optimal option for a given situation, but more often during the operation several types are combined with each other. More details about each type.

Muscle recession involves cutting off tissue from its physiological attachment point. After cutting, the muscle is sutured. The specialist selects the optimal location for its future attachment. This may be a tendon, as well as the sclera. As a result, the fiber moves back and its effect weakens. If the fiber moves forward, the action of the muscles, on the contrary, increases.
The myectomy operation involves similar manipulations with cutting off the muscle. The difference from the previous type is the absence of a suturing procedure.
Less trauma to the eye organ can be achieved using Faden surgery. In this case, manipulations with cutting off the muscle are not performed. The tissue is immediately sutured to the sclera. This procedure uses non-absorbable threads.
If a muscle is weakened and its action needs to be strengthened, shortening surgery is used. During surgery, part of the muscle is removed.
Another type of operation will help to obtain a similar effect. It involves creating a fold between the tendon and muscle. It is possible that this fold is formed inside the body of the muscle itself.

Any of the selected operations to correct strabismus is carried out in compliance with the main principles. The correction must be gradual. The operation is performed on only one eye organ. On the second, the procedure is repeated several months later (approximately 3–6). Although, with a small mowing angle, the surgeon may decide to make corrections simultaneously in both eyes, but this is often the exception.

Features of the operation

If the patient has severe strabismus, surgery is performed in several steps. The fact is that it is undesirable to perform surgery on more than two muscles at a time.

Lengthening or shortening a muscle must be carried out evenly on all sides. For example, if the muscle on the right contracts in size, then on the left it must necessarily increase. In this case, the dimensions of excision and enlargement are necessarily identical.

Observing all the main principles of surgical intervention, the specialist tries to preserve as much as possible the connection between the eyeball and the operated muscle.

For adult patients, the correction is performed under local anesthesia. Upon completion, the patient is given a bandage. You can go home after just a few hours. For children (of any age), general anesthesia is always used. The child is required to be hospitalized for a day, but cases with a longer hospital stay cannot be excluded.

Those who have the opportunity to correct pathology in foreign clinics should pay attention to German and Israeli specialists. Their approach to such correction is more radical. Almost all types of pathologies are corrected in one visit. Another plus is the possibility of performing the operation on children under one year old.

Rehabilitation period

Although the operation to correct strabismus is performed in one day and the patient is immediately sent home, this does not mean that there is no rehabilitation period. To quickly restore binocular vision, you will need to adhere to certain doctor’s recommendations for some time and perform special eye exercises.

The first day after surgery, the eye organ will be sore, slightly red and inflamed. This is a natural state. There may also be a short-term deterioration in vision. During this period, every movement must be controlled, since any attempts to touch the eye can only result in increasing pain.

Important: Restoration of the tissues of the eye organ and binocular vision occurs after a month. Most patients see a double picture all this time. If vision is not restored after this period, you should consult an ophthalmologist.

In children, adaptation time is significantly reduced. The main thing is to perform the exercises prescribed by a specialist and visit an ophthalmologist.

For active recovery, a specialist may recommend using special corrective glasses, as well as covering the healthy eye from time to time. This will help create stress on the operated organ. The muscles will develop faster and reach the desired level.

What complications should you expect after surgery?

The most common complication that occurs in medical practice after surgery to eliminate strabismus is overcorrection. It is formed when the muscles of the eye organ are excessively lengthened or sewn in. The main reasons for this undesirable effect:

surgeon error;
incorrect preliminary calculations;
the patient’s natural growth, which affects the increase in size of the eye organ.

Recently, experts have found the best way to minimize the risk of such a complication. Increasingly, operations are being carried out not by cutting, but by sewing in muscle folds. In this case, the applied suture is adjustable and the undesirable effect can be corrected in a minimally invasive way.

Formation of a rough scar at the site of muscle cutting and subsequent reattachment. This method of surgical intervention deprives the muscle tissue of mobility and elasticity, which is partially replaced by fibrous tissue. The only alternative at this time is to reduce the size of the excised area.

Strabismus returns (relapses) over time. This complication most often occurs due to the fault of the patient himself, who neglects to comply with all the rules in the postoperative period. In children, relapse can occur due to sudden increases in load on the eye organ. For example, an operation to correct strabismus was performed at the age of five or six years, and after a couple of months the child began to attend school.

The most serious, but very rare complication is damage during the operation to the vagus nerve, which is responsible for the functioning of the lungs, gastrointestinal tract and heart muscles.

Corrective surgery is a surgical intervention that makes it possible to get rid of the external manifestations of strabismus. This treatment method does not always restore the ability to see well. Surgery to correct strabismus is performed in children or adult patients who were not treated in childhood for any reason, or if the disease developed in adulthood, for example, as a result of injury.

Types of surgeries to correct strabismus

Operations can be weakening or strengthening. When performing a weakening operation, the attachment site of the extraocular muscle changes, it is transplanted further from. This weakens the action of the strong muscle (the muscle towards which the eye is deviated).

During augmentation surgery, part of the muscle is removed, it is shortened, and its attachment to the cornea does not change. This enhances the action of the weak muscle (opposite to the side to which the eye is deviated). After such interventions, the balance of muscle action is restored.

The type of operation and its technique are determined by the ophthalmic surgeon directly during the intervention. This is due to the fact that when choosing a method, many factors should be taken into account: the location of the patient’s muscles, the angle of strabismus, the condition of the oculomotor system, age and others. Usually several muscles are operated on at once, sometimes both eyes at once. In some cases, the ophthalmic surgeon combines interventions on both eyes, on both strong and weak muscles. Such operations are carried out in stages.

Result of surgical treatment

The main result of such operations is a good aesthetic effect. Most patients, both children and adults, experience significant discomfort when the eye deviates from the correct position. Surgery can solve this problem.

How is surgery to correct strabismus performed?

The operation is performed in a “one day” mode. Before performing it, local anesthesia is administered. The patient returns home the same day. After surgery, it is mandatory to follow all recommendations of the ophthalmic surgeon for the postoperative period. Final recovery occurs within about a week. But after the operation, experts strongly recommend undergoing hardware treatment.

With normal human vision, each eye sees a slightly different image. And it is the combination of the images of both eyes into a complete picture in the visual analyzer that provides binocular vision. For this, in case of strabismus, surgery alone is not enough, since the brain is not accustomed to combining images. To restore binocular vision, you need to regularly perform special exercises for a long time.

Operation video

What is strabismus, or strabismus?

Acquired strabismus occurs as a result of:

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.

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.

Carrying out the operation

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.

Source: Types of surgical intervention for strabismus

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.

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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.

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:

excessive vision correction;

Source:

Strabismus

Types of surgeries to correct strabismus

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

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.
General provisions when performing operations for strabismus

enhancing;
weakening.
excision of some portion of it (resection);
excision of part of the muscle fibers (partial myotomy).
paralytic strabismus;
preoperative preparation;
the actual operation;
postoperative recovery.
redness of the eyes;
discomfort and pain with sudden movements, in bright lighting;
various inflammatory processes in the operated areas.
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.
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.
if the doctor has decided that the correction should be gradual, one should not insist on the opposite and rush things;
fully adhere to all post-operative instructions given by the medical staff;
For adult patients, it is advisable to carry out simultaneously weakening and enhancing measures.

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.

Strabismus and its consequences

Important: Most experts are inclined to ensure that surgical intervention is performed in extreme cases. To begin with, it is recommended to try conservative methods of correcting strabismus.

Reasons for the formation of strabismus

Strabismus can be acquired or congenital. The formation of each of them has its own reasons for its occurrence. Eg.

Acquired type of strabismus

strabismus as a result of sharply deteriorated vision with astigmatism, farsightedness, and myopia;
refractive errors of the eye can be caused by developing cataracts or glaucoma, and as a result, strabismus is formed;
paralysis of the eye muscles can cause psychological disorders, as well as somatic diseases (for example: neurosyphilis, encephalitis);
a mild degree of strabismus can be caused by disturbances in blood circulation and sudden surges in pressure, and if the pathology is ignored, disability;
Experts consider childhood diseases such as scarlet fever and measles to be provoking factors for the development of strabismus.

Important: In cases where the child had a predisposition to strabismus, the pathology can manifest itself as a complication after suffering from diphtheria or influenza.

Congenital type of strabismus

Interesting: Imaginary strabismus can also be observed in adults when a person is in a state of severe intoxication.

At risk are babies whose mothers suffered from infectious diseases during pregnancy, used narcotic drugs, as well as medications without specialist prescription.

Is surgery for strabismus the only solution to the problem?

Indications for surgery

The patient used all conservative treatment methods, but no improvements were achieved (or they were not achieved to the maximum extent).
The patient wishes to eliminate cosmetic defects as soon as possible. Conservative treatment can last several months, or even years.
The patient has severe defects. The doctor considered it more expedient to first restore vision through surgery, and only then apply conservative methods to fix or improve the previously obtained result.

Important: The operation can be contraindicated only in cases where the patient has individual characteristics that are previously discussed with his specialist.

Principles and types of surgery to eliminate strabismus

Muscle recession involves cutting off tissue from its physiological attachment point. After cutting, the muscle is sutured. The specialist selects the optimal location for its future attachment. This may be a tendon, as well as the sclera. As a result, the fiber moves back and its effect weakens. If the fiber moves forward, the action of the muscles, on the contrary, increases.
The myectomy operation involves similar manipulations with cutting off the muscle. The difference from the previous type is the absence of a suturing procedure.
Less trauma to the eye organ can be achieved using Faden surgery. In this case, manipulations with cutting off the muscle are not performed. The tissue is immediately sutured to the sclera. This procedure uses non-absorbable threads.
If a muscle is weakened and its action needs to be strengthened, shortening surgery is used. During surgery, part of the muscle is removed.
Another type of operation will help to obtain a similar effect. It involves creating a fold between the tendon and muscle. It is possible that this fold is formed inside the body of the muscle itself.

Features of the operation

If the patient has severe strabismus, surgery is performed in several steps. The fact is that it is undesirable to perform surgery on more than two muscles at a time.

Observing all the main principles of surgical intervention, the specialist tries to preserve as much as possible the connection between the eyeball and the operated muscle.

Rehabilitation period

Important: Restoration of the tissues of the eye organ and binocular vision occurs after a month. Most patients see a double picture all this time. If vision is not restored after this period, you should consult an ophthalmologist.

In children, adaptation time is significantly reduced. The main thing is to perform the exercises prescribed by a specialist and visit an ophthalmologist.

What complications should you expect after surgery?

surgeon error;
incorrect preliminary calculations;
the patient’s natural growth, which affects the increase in size of the eye organ.

The most serious, but very rare complication is damage during the operation to the vagus nerve, which is responsible for the functioning of the lungs, gastrointestinal tract and heart muscles.

Strabismus rarely requires surgery. Operation on strabismus It is carried out only for cosmetic purposes, to develop binocular vision and in the presence of serious complications.

This article is useful to anyone who suffers from heterotropia and is planning to have surgery. You will learn what types of surgical interventions exist, how the treatment is carried out, and how long the rehabilitation period lasts.

Need for surgery

Surgery to correct strabismus is performed at any age. It is less common in children than in adults because it is easier to treat.

Also, at any age, visual defects in appearance, especially such as strabismus– a powerful traumatic factor affecting self-esteem.

In general, surgical treatment is designed to correct imbalances in the movement of all six muscles that control the position of the main ocular axis.

Surgical treatment of childhood strabismus

The most effective surgical treatment for heterotopia in children is to perform the procedure between the ages of 4 and 5 years. If it is truly inevitable and necessary.

Congenital ophthalmological pathology, which is characterized by a significant angle of deviation from the natural position, can be treated earlier.

The standard age for surgical intervention in this area was chosen for a reason.

The most effective outcome occurs only if the patient is aware of what is happening. This is necessary because during the rehabilitation period a person needs to perform a simple series of eye exercises, which will consolidate the effect of the procedure. And, as you know, babies are not capable of this due to lack of awareness.

Important: All children, regardless of age, have eye surgery that cures strabismus, is performed under general anesthesia. In some cases, even short-term hospitalization is provided.

Treatment of strabismus in adults with surgery

In adults, unlike children, surgery to eliminate heterotopia takes place on an outpatient basis.

Most doctors say that a week is enough for a full recovery after this type of surgery. But binocular vision will take much longer to recover.

Time is needed, because during strabismus the brain turned off the work of a non-functioning organ and it needs to restore the functionality of the detached channel. For this purpose the following are assigned:

eye exercises;
plenoptic therapy;
orthopedic therapy.

The one-day operation in adults is performed under local anesthesia and does not require hospitalization.

Classification of surgical treatment methods

There are only two main types of operations designed to get rid of strabismus:

debilitating;
reinforcing.

If the reason for the deviation of the pupil from the natural axis is overstrain of the eye muscles, the following methods are used:

recession;
partial myotomy;
plastic surgery of the oculomotor muscle—its partial removal.

To treat weakened muscles, there are surgical procedures such as:

resection;
tenorrhaphy;
Faden procedure;
anteposition.

It rarely happens that the disease occurs due to dysfunction of one muscle. More often it happens that several muscles begin to work poorly, and surgery is performed on all of them.

Principles of surgical treatment

Important: The principles of the procedure lie in the most optimal sequence and combination of preliminary, main and postoperative measures.

Surgical intervention involves:

Step-by-step approach– relevant for strabismus in both eyes. First, surgery is performed on the first eye, and a few months later on the second eye.
Calculating sizes areas of muscles with which forced correction work is carried out is carried out according to established patterns.
Shortening/lengthening muscles carried out evenly on both sides.
Preferably maintain a natural connection corrected muscle with organ.
With significant strabismus It is not recommended to perform surgery on more than two muscles at once one eye.

Some doctors may claim that it cannot be cured by surgery. This is true, but only in relation to standard methods for conducting such events.

Recently, an exceptional method has been developed to restore the functionality of paralyzed oculomotor muscles.

If this type of strabismus is treated with standard methods, the consequences are often unpredictable: the eye moves limitedly, uncontrollably, or after a while stops moving again.

Indications and contraindications

The operation is performed exclusively in cases where therapeutic methods do not bring the desired effect or there is no other way out. Only as a last resort.

Surgery is prescribed only under the following circumstances:

the patient’s desire to get rid of the visual defect;
conservative methods are inappropriate;
on the recommendation of an ophthalmologist, who believes that the only way to restore vision is surgery.

Fact: Contraindications to surgical treatment of strabismus can only be the individual characteristics of the patient, which are discussed with the ophthalmologist when making a decision.

Rehabilitation period

Even after a one-day operation, there is a specific period during which it is necessary to carry out procedures to improve your own condition and quickly restore binocular vision.

Post-operative pain is normal

Immediately after surgery, the anesthesia wears off, and the eye will hurt for some time - this is natural.

Attempts or unconscious movements of the corrected organ of vision will only intensify the pain syndrome.

The eye itself will be red and slightly inflamed, with temporary slight blurring of vision.

Fact: Adults often see double vision for some time after surgery.

Restoration of full binocular vision and eye tissue is completed one month after surgery.

Children experience this process faster, but both need to visit the ophthalmologist frequently at this time and do eye exercises.

Read about what glasses are prescribed for strabismus.

Visual differences before and after surgery strabismus visible in the photo below.

Possible complications

No matter how high the price of the operation, and no matter how high the chosen clinic has a list of recommendations, no one is immune from unforeseen consequences.

Complications from strabismus surgery are not so different as they are dangerous.

Now there will be a moment of revelation, you can skip it =) My squint officially began in school. If not officially, it seems to me even since kindergarten, because I remember as a little girl that I liked the double appearance in my eyes. My parents, unfortunately, did not force me to take treatment at the time, although it was prescribed. There have been many embarrassing situations in life, and despite the fact that I have a family and children, my husband doesn’t care where my eyes look =) I still didn’t feel comfortable appearing in public. A relative’s phrase: “Tell me, are you looking at me or at the wall?” - was the last straw. While my memory is fresh, I’ll tell you about this horror =)

That's what the trouble was. Both eyes left alternately. Concomitant divergent strabismus.

Our ophthalmologist gave me a referral from compulsory medical insurance for a consultation about an operation at this institute.

Clinic

I warn you right away, you need to sign up in advance. My doctor said you can go through right away - you can’t, or rather you can, but you have to pay. I don’t remember exactly, but I’ll definitely have to shell out 2 thousand. And I'll tell you right away - it's not worth it. Absolutely everyone, both paid and free, in this clinic sits in long queues. It's better to be free, it won't be so offensive. You need to arrive early for the opening. Otherwise, you risk getting stuck in a traffic jam at the initial stage - registration. The queue is electronic. After I created the card, they gave me a “slider” of the offices that I should visit.

In the first office, they checked my vision, intraocular pressure, and also how I understood my lateral vision (a spherical device along which a red dot runs and you need to tell me at what moment it disappears). The next room is needed to determine the angle of strabismus. This is where the confusion began. The fact is that when the eye is relaxed, it looks outward, but! I have become so accustomed to putting it in place that the device showed me that the angle is positive - i.e. the eye deviates towards the nose =)

To clarify the circumstances, I have already been referred to a doctor. There I sat in line for 3 hours. No joke. Everyone was sitting there, both paid and free. One payer tried to break through - but he was almost eaten there). Ultimately, I stayed at the clinic from 7:30 a.m. to 4 p.m. So don't forget to take some food with you =)

Doctor's office.

There turned out to be a pleasant woman of non-Russian appearance, and for a long time she forced me to look first at my pen, then at the flashlight on my phone. It turned out that I have a rather rare form of strabismus. Inconstant, with preserved (as they say) binocular vision. Those. With both eyes I see one picture. As she explained, they usually see two. She was able to find out how much the eye deviates using the “overlap test”: she closes the affected eye with her palm for 5 seconds, then removes the hand and the eye is always deviated as much as it is. It turned out that I had a 20 degree angle, as she explained, perhaps even more. Of course, I wanted the operation for free, for this I had to wait a month for the certificate, during which time I had to undergo the necessary tests and doctors. The date was set - October 4. On this day, I had to come to her with my things, get documents and go to the hospital. They chose the left eye, it seemed to me that it goes away more often. The doctor explained that if it is possible to eliminate the entire angle, then the second eye will not leave.

What you need to undergo before the operation (attention! I was given a referral for all these examinations by an ophthalmologist from the district clinic - not a general practitioner):

General urine analysis
Clinical blood test
Blood chemistry
Fluorography
Dentist
If you have diabetes - an endocrinologist
Therapist (last)
A certificate stating that you were sick or vaccinated against measles (they simply photocopied my childhood vaccination plate and gave me a clinic stamp)

Day X.

Despite the fact that I warned the doctor that I was being hospitalized, I still spent an hour and a half again. After that, they gave me all the necessary documents and sent me to the hospital, it is located to the right of the clinic, if you look at the entrance.

Make a photocopy of your health insurance policy right away! Otherwise they will send you back to the clinic to do it for 5-10 rubles. Like me.

I would also like to warn you - there is no food on the first day of hospitalization! Although they said that there was still food left and they could put in less, but still put it in. It apparently depends on your disruptive nature. But I will say that before the operation I don’t really want to eat =).

I was processed, outerwear and shoes are handed over there, and upon discharge they will give me a piece of paper to give them back. And I and several other people were taken to the 4th floor.

The department was extremely quiet. To me, accustomed to hospitals and maternity hospitals, where life is in full swing, it seemed simply empty here. They even called a nurse for us. =) But I must note that it is very clean, cozy, there are soft sofas, and they turn on the TV in the evening. The ward is divided into 2 boxes with 2 beds. Total 4. There is a shared bathroom for the ward, but there is one shower for everyone, for 3 stalls. But they don’t stay there for long. For the first week after surgery, water should not get into the eye.. Be as perverted as you want, it’s called =) Everything in the room is also renovated, simple but cozy, I was generally pleased with the drawer, it’s so modern =) And not broken! =)))) I was lucky with my neighbor; she turned out to be a woman with the same problem. There was someone to be afraid of. No doctor approached us that day; we were left alone with our fears. But the neighbor said that tomorrow morning she will be operated on, which means me too.

In the morning they brought us a uniform, I of course drowned in it, a shirt, pants and shoe covers. But everything is new, still in packaging.

Afterwards, everyone was called into the examination room one by one, and the same doctor who prescribed the operation saw me. First they took my neighbor, then me and 3 other people. It was around 12 noon. In the operating room we were seated on a bench; the operating rooms were very reminiscent of maternity ones. Large glass windows, you can see everything... They called me first, sat me in a chair and began asking me about chronic diseases, allergies and so on. Then a nurse came and injected a sedative into my shoulder. Then the uncle professor came up and told me to look clearly at the ceiling and not move my eye. After that, he injected anesthesia under the eye. You know, compared to an injection in the shoulder, it doesn’t hurt at all, even a mosquito bites harder. It was just an unpleasant feeling, but then the doctor pressed very, very hard on the injection site and held it there, it even hurt my eye. then he put my hand in place of his and told me to hold it like that for 15 minutes. I'll tell you, it's hard to push as hard as I can, plus during this time I thought 10 times - should I run away? =) But I restrained myself, convincing myself that childbirth was worse. After that, they took me to the operating room, put me on the couch, and injected something else into my vein. They covered it with a cloth and that’s it, I didn’t see anything else - they told me that the eye is illuminated, and it doesn’t see. The neighbor later said that she saw only a cloudy, cloudy spot. It was a huge relief for me; most of all I was afraid of SEEING. When it turned out that the same doctor who prescribed and examined me would be operating on me, I almost completely relaxed. She has such a pleasant voice, like Neytiri from Avatar =)) She was assisted by the same pleasant nurse. The constant words “that’s it, okay” in a soft voice really calmed me down. From sensations. Almost nothing is felt, only occasionally a slight pressure and I had a slight tingling sensation. Before the operation, the professor said that if the tingling is tolerable, do not distract the doctor. Even when it was a little stronger, I remained silent, as it turned out, that’s where it all ended.

The operation lasted less than an hour; 2 muscles were operated on. On one there is a recession of 2 mm - this was moved from one place a little back, i.e. weakened. And on the other, a 4 mm resection, this is when a piece is cut out from the middle and stitched back together, i.e. turns out to be strengthened. If there was only one, they said it would take up to half an hour. Then they applied a bandage, secured it with a plaster and took me to the department. The neighbor was already lying there. Apparently the sedatives took their toll, we slept until dinner. I was too lazy to even call; I noticed that my neighbor was constantly dropping calls. We had dinner and went to bed again, but I couldn’t sleep, my eye was very painful, there was a feeling of a tightly stretched string in the eye. In the evening we were called to dig in, where the nurse soaked our eyelashes for a long time. When the eye opened, I was scared, there were 2 pictures and they were at different levels, one higher, the other lower, but the next day it became better. I complained of severe pain and she gave me a painkiller injection. The neighbor was only worried about the bandage =) She didn’t like to see out of one eye =)

Yes, yes, they don’t stay there for long =)) We had breakfast, we were called back to the examination room, the doctor was pleased with the result. She explained that the final result will be visible only after 3 months. Be sure to wear glasses (I have myopia -3) - otherwise, if the eye sees poorly, it may leave again. After a couple of weeks, the threads (self-absorbing) may come out, and there may be discomfort. They gave me a discharge and the go-ahead to go home. The neighbor was asked to stay another day; her case was more serious. It was unusual to go home with a blindfold, and the path was not close, but the otaku’s imagination pictured all sorts of anime characters with blindfolds in my head and it was even funny =) At home, one child was scared of me, the second was simply happy about his mother)). The eye was swollen and red, but I expected to see this, so I wasn’t particularly upset.

First week.

At first I was prescribed Signicef and Dexamethasone 3 times a day. The first week it was terrible to sleep. Under the swollen eyelids, tears accumulated and at night I woke up, opened them and a stream just flowed out of my eyes, and if I didn’t wake up, it became more painful. My nose was also constantly running. There was constant pain in my eye. I even took pills. And the feeling is painful, like a corneal injury, I had a similar experience. It got to the point that after 4 days I couldn’t sleep at night. And in the afternoon I rushed to a paid ophthalmologist. As it turned out, there really was a corneal injury. The doctor suggested that when the nurse washed my eye after the operation it could have caused damage. Hyloparin was added to the previous drops.

After visiting the district clinic, I was told to undergo observation there. It turned out that the swelling was too strong, they also added Zyrtec orally at night, Nevanac drops and Floxal ointment. Do not eat anything that retains liquid and do not drink too much water. And considering that all this needs to be dripped 4 times a day, and there is also a break between drops of half an hour. You can drip almost without a break =) Naturally I skip it.

At first the eye gets very tired, you have to blink very often, it seems that it is constantly dry, despite the fact that it is watering. It was hard only for the first week in the sun, then I walked as normal.

Preliminary results.

The operation took place a little over 3 weeks ago. There is still swelling, redness and swollen mucous membrane are visible at the inner edge of the eye, there are small black dots there and under the upper eyelid, apparently stitches.