Post-Retinal Detachment Surgery: Addressing Eye Control Issues

Postoperative Issues After Retinal Detachment Surgery

Hello Doctor, I have had congenital amblyopia and a slight strabismus since childhood.
During my development, my vision was not well managed, leading to high myopia in both eyes, around 800-900 degrees.
In middle school, I possibly suffered a retinal detachment in my right eye due to an impact.
After undergoing scleral buckle surgery, the retinal detachment was successfully treated.
However, I later noticed that my right eye does not move as freely as it should.
For example, when I focus on a point more than one meter away, my right eye tends to turn inward involuntarily, resembling cross-eyed vision, while my left eye functions normally.
This often occurs in situations like taking photos or having face-to-face conversations, or when I look to the right, I feel an unnatural sensation.
I previously consulted a doctor (not the one who performed my surgery), and he mentioned that the surgery may have caused issues with the eye muscles and suggested that hyaluronic acid injections could improve the situation.
However, this suggestion raised some concerns for me.
I hope to receive clarification on this matter.
Thank you.

Lai, 10~19 year old female. Ask Date: 2019/05/01

Dr. Liang Ce reply Ophthalmology

It is recommended that you seek additional opinions from other ophthalmologists, consider multiple suggestions, and then decide on the treatment approach.
Wishing you good health.

Reply Date: 2019/05/01

More Info

Hello! Thank you for sharing your concerns regarding the issues you are experiencing after your retinal detachment surgery. It’s understandable to have questions about the changes in your vision and eye control, especially after such a significant procedure. Let’s address your concerns step by step.

Understanding Post-Surgery Eye Control Issues
1. Eye Muscle Imbalance: After retinal detachment surgery, it is not uncommon for patients to experience changes in eye alignment and control. The surgery can affect the muscles around the eye, leading to conditions such as strabismus (misalignment of the eyes), which may explain the inward turning of your right eye when focusing on distant objects. This can happen due to the alteration of the eye's position or the muscle's ability to coordinate effectively post-surgery.

2. Impact of Amblyopia: Given your history of congenital amblyopia (lazy eye) and strabismus, your brain may have developed a preference for the left eye, which can complicate the control of the right eye after surgery. The brain's adaptation to these visual inputs can lead to difficulties in controlling eye movements, especially when focusing on objects at varying distances.

3. Potential Solutions:
- Vision Therapy: One of the most effective ways to address issues with eye control is through vision therapy. This is a structured program of visual activities designed to improve coordination and control of the eyes. Working with a vision therapist can help retrain your brain to better coordinate the movements of both eyes.

- Prism Glasses: Sometimes, prism glasses can be prescribed to help align the images seen by both eyes, which can alleviate some of the discomfort and improve visual function.

- Botulinum Toxin Injections: While you mentioned the suggestion of using hyaluronic acid injections, botulinum toxin (Botox) is another option that some doctors use to temporarily weaken specific eye muscles, which can help in realigning the eyes. This is a more common approach for strabismus and may be worth discussing with your ophthalmologist.

4. Consultation with Specialists: Since your situation is complex, it may be beneficial to seek a second opinion from a strabismus specialist or a neuro-ophthalmologist. They can provide a more tailored approach to your specific needs and help determine the best course of action.

Addressing Your Concerns About Treatment Options
- Surgical Risks: As with any surgical procedure, there are risks involved. However, advancements in surgical techniques have improved outcomes significantly. If surgery is suggested, ensure you discuss the potential benefits and risks thoroughly with your surgeon.

- Non-Surgical Options: If you are hesitant about surgical interventions, exploring non-surgical options like vision therapy or prism glasses may provide relief without the risks associated with surgery.

Conclusion
In summary, the changes you are experiencing in eye control after your retinal detachment surgery could be attributed to muscle imbalances and the history of amblyopia. Engaging in vision therapy, considering prism glasses, or exploring botulinum toxin injections could be beneficial. It’s essential to have open discussions with your healthcare providers about your concerns and the best strategies moving forward. Remember, you are not alone in this journey, and there are professionals who can help guide you through the recovery process. Thank you for reaching out, and I hope this information helps you find clarity and comfort in your situation!

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Recommendations: 1. Discuss the above situation further with your attending physician. 2. Alternatively, seek consultation at another ophthalmology medical facility. Thank you. Wishing you good health!