Post-Surgery Concerns: Intermittent Exotropia After Strabismus Surgery

Q: Post-Surgery Concerns: Intermittent Exotropia After Strabismus Surgery

Hello, Mr. <br>Adé： Whether the eye position is aligned or misaligned requires evaluation by a specialist. <br>Please consult the surgeon for a clearer assessment. <br>Sometimes, if the eye position is significantly misaligned, complete correction may not be possible. <br>In Taiw

One month after surgery for intermittent strabismus in both eyes, it was found that there is still an outward deviation?

Hello, I have had amblyopia and nystagmus since childhood, along with intermittent exotropia in both eyes.
I previously lacked the courage to undergo surgery, but about a month ago, I had strabismus surgery on both eyes.
Now, less than a month post-surgery, I am using iodine ointment, but I notice that upon waking up, both eyes are noticeably deviated outward, and it takes washing my face for them to return to normal.
What could be the reason for this? Sometimes when talking with family, they mention that my eyes still tend to drift outward.
Does this indicate a failed surgery? During my last two follow-up appointments, the doctor said the results were still quite good.
If it is confirmed to be a failure, is there a chance that a second surgery could yield better results? Thank you for your questions.

A De, 30~39 year old female. Ask Date: 2016/09/14

Dr. Gao Pilin reply Ophthalmology

Hello, Mr.
Adé: Whether the eye position is aligned or misaligned requires evaluation by a specialist.
Please consult the surgeon for a clearer assessment.
Sometimes, if the eye position is significantly misaligned, complete correction may not be possible.
In Taiwan, the Department of Ophthalmology at Puzi Hospital is open Monday to Friday from 8:00 AM to 12:00 PM and Wednesday afternoons from 1:00 PM to 4:30 PM.
Online responses can only serve as a reference; it is necessary to visit a medical facility for treatment.
I hope to have the opportunity to assist you.
Best regards, Gao Pilin.

Reply Date: 2016/09/14

More Info

After undergoing strabismus surgery, it is not uncommon for patients to experience some degree of intermittent exotropia, especially in the early postoperative period. Strabismus surgery aims to realign the eyes by adjusting the muscles that control eye movement. However, the healing process can vary significantly among individuals, and several factors can contribute to the symptoms you are experiencing.

Firstly, the presence of intermittent exotropia shortly after surgery can be attributed to several reasons:
1. Healing Process: After surgery, the muscles and tissues around the eyes are healing. Swelling, inflammation, and changes in muscle tone can temporarily affect eye alignment. It may take several weeks for the muscles to stabilize and for the brain to adjust to the new alignment.

2. Residual Strabismus: It is possible that the surgery did not fully correct the misalignment, leading to residual exotropia. This can happen if the initial muscle adjustments were not sufficient to achieve the desired alignment.

3. Overcorrection or Undercorrection: Sometimes, the surgical outcome can lead to overcorrection (where the eyes turn inwards) or undercorrection (where the eyes remain outward). This can manifest as intermittent exotropia, particularly when the eyes are tired or when focusing on nearby objects.

4. Visual Fatigue: If you have a history of amblyopia (lazy eye) and nystagmus (eye shaking), your visual system may still be adjusting to the changes post-surgery. Fatigue can exacerbate the misalignment, especially during prolonged visual tasks.

Regarding your concerns about whether this indicates a surgical failure, it is essential to understand that not all postoperative symptoms signify failure. Your surgeon's assessments during follow-up visits, where they mentioned that the results were satisfactory, suggest that the surgery may still be deemed successful despite the intermittent exotropia you are experiencing.

If you are concerned about the possibility of needing a second surgery, it is crucial to have an open discussion with your ophthalmologist. They can evaluate your eye alignment, assess the degree of exotropia, and determine whether further intervention is necessary. In some cases, additional surgery may be beneficial, especially if the misalignment persists or worsens over time.

In the meantime, here are some recommendations to manage your symptoms:
- Follow-Up Appointments: Keep all scheduled follow-up appointments with your ophthalmologist. They will monitor your recovery and make necessary adjustments to your treatment plan.

- Eye Exercises: Your doctor may recommend specific eye exercises to help strengthen the eye muscles and improve coordination. These exercises can be beneficial in enhancing visual alignment.

- Patience: Understand that the healing process can take time. It is common for patients to experience fluctuations in eye alignment during the recovery phase.

- Visual Habits: Be mindful of your visual habits. Taking regular breaks during tasks that require intense focus can help reduce fatigue and improve comfort.

In conclusion, while intermittent exotropia after strabismus surgery can be concerning, it is not uncommon and does not necessarily indicate surgical failure. Continuous communication with your healthcare provider will be key to addressing your concerns and ensuring the best possible outcome for your vision.

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