Post-Strabismus Surgery: Dealing with Uneven Eyes - Ophthalmology

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Postoperative anisometropia after strabismus surgery?


Hello Doctor: I underwent strabismus surgery on my left eye on September 23rd, but since the surgery, I have been experiencing an issue with uneven eyes, although the eye position has returned to normal.
I have repeatedly followed up with the surgeon, who has only advised me to wait for recovery.
However, it has been three months, and the problem with uneven eyes persists.
I am at a loss about what to do.
I have also consulted general ophthalmology clinics, and they have stated that strabismus surgery should not cause uneven eyes (I did not have this issue before the surgery).
There is very little information available online regarding similar cases.
Have you encountered such cases before? I am really anxious and worried that I may not recover.
Would you recommend undergoing a ptosis correction surgery to address the issue of uneven eyes? Thank you.

An, 20~29 year old female. Ask Date: 2017/01/02

Dr. Gao Pilin reply Ophthalmology


Hello, if your doctor tells you that you will gradually recover, they certainly have experience in this area, so please rest assured and wait.
If there is indeed a difference in eye size, I believe your doctor can help you correct it.
The ophthalmology department at Puzi Hospital in Taiwan 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; if necessary, you should visit a medical institution for treatment.
I hope to have the opportunity to serve you.
Gao Pilin

Reply Date: 2017/01/02

More Info


Post-strabismus surgery, particularly when it involves a single eye, can sometimes lead to complications such as the perception of uneven eyes or "大小眼" (big and small eyes). This phenomenon can be distressing for patients, especially when they have undergone surgery with the expectation of improved alignment and appearance.
Firstly, it is essential to understand that strabismus surgery aims to correct the alignment of the eyes by adjusting the muscles that control eye movement. While many patients experience significant improvements in eye alignment post-surgery, some may still perceive differences in size or position between their eyes. This can be due to several factors, including the healing process, muscle adjustments, or even the way the brain processes visual information after surgery.

In your case, since you have been experiencing this issue for three months post-surgery, it is understandable to feel anxious. It is not uncommon for patients to have concerns about the results of their surgery, especially when they notice discrepancies that were not present before. The fact that your eye position has normalized is a positive sign, but the perception of unevenness can persist for various reasons.

1. Healing Process: After strabismus surgery, the muscles and surrounding tissues need time to heal. Swelling and inflammation can temporarily affect the appearance of the eyes. It is possible that as healing progresses, the perceived size difference may diminish.

2. Muscle Adjustment: The muscles that control eye movement may take time to adjust to their new positions. This adjustment period can lead to temporary visual discrepancies, including the perception of one eye appearing larger or smaller than the other.

3. Brain Adaptation: The brain plays a crucial role in how we perceive our eyes. After surgery, the brain may take time to adapt to the new alignment, which can affect how you perceive the size and position of your eyes.

4. Underlying Conditions: If there were any pre-existing conditions that contributed to the strabismus, they may still influence the appearance of your eyes post-surgery.

Regarding your question about whether to consider a second surgery, such as a "提眼肌手術" (levator muscle surgery), it is essential to consult with your ophthalmologist or the surgeon who performed the initial procedure. They will be able to assess your specific situation and determine if further intervention is necessary. In some cases, additional surgery may be warranted if there is a significant functional or cosmetic concern that does not resolve over time.

It is also worth noting that while some patients may require additional procedures, others may find that their perception of unevenness improves with time and patience. Regular follow-up appointments with your surgeon are crucial, as they can monitor your progress and provide guidance on the best course of action.

In summary, while it is understandable to feel concerned about the appearance of your eyes post-surgery, it is essential to give your body time to heal and adjust. Keep in close contact with your healthcare provider, and do not hesitate to express your concerns during follow-up visits. They can provide reassurance and help you navigate your recovery process effectively.

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