Is Surgery Necessary for Intermittent Strabismus with Amblyopia?

Q: Is Surgery Necessary for Intermittent Strabismus with Amblyopia?

Q： Do I need to undergo strabismus correction surgery? A： It is recommended that you visit an ophthalmology clinic for an evaluation by a physician to determine if any further examinations are necessary. <br>Thank you, and wish you good health!

I would like to inquire about intermittent exotropia in one eye accompanied by amblyopia. Is it necessary to undergo surgical correction?

Hello, doctor.
I am a strabismus patient from mainland China.
Due to the poor consultation platforms and doctors in my country, I thought to seek advice here.
I have strabismus accompanied by amblyopia, and I would like to know if surgery is necessary.
If I undergo surgery, how likely is it to recur afterward? I have had amblyopia since childhood, but it was not detected in time for treatment.
By the time I was 14 and in middle school, I noticed a significant intermittent exotropia in my left eye (I was unaware of any strabismus before).
I immediately went to the ophthalmology outpatient department of a local city hospital, where the doctor recommended surgical correction.
However, my mother and family strongly opposed the surgery, fearing complications or potential blindness if the surgery did not go well, as well as the possibility of recurrence.
To this day, I have not undergone any correction.
Additionally, I have been exposed to electronic screens for a long time, which has led to some dry eye symptoms.
I cannot consciously control my left eye to align properly; sometimes it naturally aligns, but most of the time, there is varying degrees of exotropia (especially noticeable when looking down or when fatigued).

So, doctor, do I really need to undergo strabismus correction surgery? The lack of correction has severely impacted my studies, employment, interpersonal communication, and relationships.
I have little hope for romance or companionship; my appearance is not attractive, and with strabismus, girls tend to either hurry past me to avoid interaction or laugh at me behind my back.
Living in mainland China, my left eye strabismus has made me acutely aware of the systemic issues around me.
I live in a small fourth-tier city, and my family's economic situation places us at the bottom of the social ladder in China, exposing me to many unpleasant individuals.
Wealthy people look down on someone like me, who has no money or status.
When I work as a security guard in a so-called "wealthy area" (not officially named, but it is a city development zone with many affluent residents), I occasionally hear condescending remarks like "idiot" or "fool" from passing cars (due to my appearance).
Although I try to overlook my left eye strabismus when I look in the mirror and don't consider myself unattractive, I have been called "foolish" behind my back during my school years.
In our culture, insults are often made indirectly, which is even more hurtful.
I have been subjected to bullying and isolation by classmates, and no one has explained the reality of my situation to me.
I feel as though I must have done something terrible in a past life to deserve this suffering.
Living within this system, coming from a poor single-parent family, and having strabismus, people often label me as disabled or blind.
Ironically, my strabismus and amblyopia do not meet the criteria for disability benefits.
Even my mother had to rely on relatives to navigate the system for years to apply for her own basic assistance.
What kind of government is this? Finding a job is impossible; with no money and no looks, I have no hope of finding a partner.
I lack even the most basic living security.
Does the Chinese Communist Party even allow the lower class to survive? I will be 21 this year, and I feel lost about my future.
I realize that it is not just strabismus that has ruined my life, but also the ugliness and hypocrisy of human nature in this world.
I sometimes wish the United States would drop an atomic bomb on this wretched city to level it.

I apologize for going off-topic.

Vohum, 20~29 year old female. Ask Date: 2021/05/01

Dr. Liang Ce reply Ophthalmology

Q: Do I need to undergo strabismus correction surgery? A: It is recommended that you visit an ophthalmology clinic for an evaluation by a physician to determine if any further examinations are necessary.
Thank you, and wish you good health!

Reply Date: 2021/05/01

More Info

Intermittent strabismus, particularly when associated with amblyopia (often referred to as "lazy eye"), can significantly impact an individual's quality of life, including their social interactions, academic performance, and self-esteem. The decision to pursue surgical intervention for strabismus is multifaceted and should be approached with careful consideration of various factors.

Understanding Intermittent Strabismus and Amblyopia
Intermittent strabismus is characterized by the misalignment of the eyes that occurs occasionally, rather than constantly. This condition can lead to amblyopia, where the brain favors one eye over the other, resulting in reduced vision in the affected eye. Early intervention is crucial, as the critical period for treating amblyopia typically occurs in childhood. If left untreated, amblyopia can become permanent, leading to lifelong visual impairment.

Surgical Considerations
Surgery for strabismus is often recommended when non-surgical treatments (like glasses or vision therapy) have not yielded satisfactory results, especially if the strabismus is affecting the patient's quality of life. Here are some key points regarding the necessity and implications of surgery:
1. Timing of Surgery: The optimal time for strabismus surgery is usually before the age of 18, as the brain's plasticity decreases with age. However, adults can still benefit from surgery, especially if they have been living with the condition for years.

2. Surgical Outcomes: Strabismus surgery aims to realign the eyes and improve binocular vision. While many patients experience significant improvement, there is a possibility of recurrence. Factors influencing the success of surgery include the degree of misalignment, the presence of amblyopia, and the patient's age at the time of surgery.

3. Postoperative Care: After surgery, patients may need to engage in vision therapy to maximize the benefits of the procedure, particularly if amblyopia is present. Regular follow-ups with an ophthalmologist are essential to monitor recovery and address any complications.

4. Risks and Complications: As with any surgical procedure, there are risks involved, including infection, bleeding, and the potential for overcorrection or undercorrection of the strabismus. Discussing these risks with a qualified ophthalmologist can help alleviate fears and provide a clearer understanding of what to expect.

Addressing Concerns About Recurrence
Concerns about the recurrence of strabismus after surgery are valid. While some patients may experience a return of misalignment, many factors can influence this outcome:
- Type of Strabismus: Certain types of strabismus are more prone to recurrence than others.

- Surgical Technique: The skill and experience of the surgeon play a critical role in the success of the procedure.

- Patient Compliance: Following postoperative instructions and engaging in any recommended vision therapy can significantly impact long-term outcomes.

Emotional and Social Considerations
Your experiences with social stigma and personal challenges due to strabismus and amblyopia are deeply concerning. It's important to recognize that these feelings are valid and shared by many individuals facing similar challenges. Seeking support from mental health professionals, support groups, or online communities can provide a safe space to express your feelings and gain insights from others who have navigated similar paths.

Conclusion
In summary, surgery for intermittent strabismus with amblyopia can be a beneficial option, particularly if the condition has negatively impacted your life. It is essential to consult with a qualified ophthalmologist who specializes in strabismus to discuss your specific situation, potential benefits, risks, and the likelihood of recurrence. Addressing both the physical and emotional aspects of your condition is crucial for holistic well-being. Remember, seeking help and support is a sign of strength, and there are resources available to assist you in navigating these challenges.

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