Can Surgery Correct Strabismus After Previous Failures?

Q: Can Surgery Correct Strabismus After Previous Failures?

Hello, Madam： You previously underwent strabismus surgery to correct your eye misalignment, but it has since deviated again, and you experienced an unsatisfactory secondary surgery. <br>Generally, the difficulty of a repeat surgery is inherently higher. <br>Additionally, do you h

Strabismus

I have had acquired right eye strabismus since childhood and underwent surgery for correction 35 years ago.
The strabismus reappeared 15 years ago, and due to psychological factors, the subsequent surgery on the same eye was unsuccessful.
One explanation for this is that during my first surgery, the eye muscle was severed, making successful correction impossible.
I have read your published work stating: "In terms of visual function, if the strabismic eye has a function classified as amblyopia, even after a successful strabismus surgery that restores normal eye position, some patients, especially those with very poor-functioning amblyopic eyes or even no function, may still have a chance of misalignment again in the future, typically increasing over time." Given my condition, is it possible to undergo another corrective surgery? At this point, I do not seek to restore vision but simply wish to have a symmetrical appearance like that of a normal person.
Could you please advise if another corrective surgery is feasible? Thank you.

candy, 50~59 year old female. Ask Date: 2006/07/29

Dr. Liu Jingxian reply Ophthalmology

Hello, Madam: You previously underwent strabismus surgery to correct your eye misalignment, but it has since deviated again, and you experienced an unsatisfactory secondary surgery.
Generally, the difficulty of a repeat surgery is inherently higher.
Additionally, do you have any issues with amblyopia? In cases of amblyopia, even after a successful strabismus surgery that restores normal eye alignment, there is a high likelihood that the amblyopic eye may deviate again, often increasing over time.
Therefore, whether to recommend another surgery should be based on a comprehensive evaluation before deciding on the treatment direction.
Wishing you good health.
Dr.
Liu Ching-Hsi, Ophthalmology, Taipei City Hospital, Zhongxing Branch.

Reply Date: 2006/07/29

More Info

Strabismus, commonly known as squint or crossed eyes, can be a challenging condition to treat, especially after previous surgical failures. Your history of strabismus, with surgeries performed 35 years ago and again 15 years ago, indicates a long-standing issue that may involve complex factors affecting the eye muscles and visual function.

To address your question about the possibility of corrective surgery after previous failures, it is essential to consider several factors:
1. Assessment of Eye Muscles: The first step is to have a thorough evaluation by an ophthalmologist or a strabismus specialist. They will assess the current alignment of your eyes, the strength and function of the eye muscles, and any potential scarring or changes from previous surgeries. If the eye muscles were cut during your first surgery, this could complicate future surgical options, but it does not necessarily preclude them.

2. Visual Function: As you mentioned, if the affected eye has poor visual function or is classified as amblyopic (lazy eye), this can impact the success of any corrective surgery. While surgery can align the eyes, it may not improve visual acuity if the brain has not developed the ability to use the affected eye effectively. In some cases, even with successful alignment, the eye may revert to its previous position over time, especially if the underlying visual issues are not addressed.

3. Surgical Options: If your eye muscles are still functional and there is no significant scarring that would prevent further surgery, a strabismus surgery could be considered. This may involve either resection (shortening) or recession (lengthening) of the eye muscles to achieve better alignment. The specific approach will depend on the type and degree of strabismus you have.

4. Expectations and Goals: Since your primary goal is cosmetic—achieving a more symmetrical appearance—it's important to discuss this with your surgeon. They can provide insights into what can realistically be achieved with surgery. While many patients experience improved alignment, the degree of success can vary, and some may still experience residual misalignment.

5. Risks and Considerations: As with any surgery, there are risks involved, including the possibility of overcorrection or undercorrection, which may necessitate additional procedures. It's crucial to have a candid discussion with your surgeon about these risks and the likelihood of achieving your desired outcome.

6. Postoperative Care: If you do proceed with surgery, postoperative care and follow-up will be critical. This may include vision therapy, especially if there are concerns about amblyopia or other visual deficits.

In conclusion, it is possible to consider another surgery for strabismus correction, but it requires a comprehensive evaluation by a qualified specialist. They will take into account your unique history, the current state of your eye muscles, and your visual function. Open communication about your goals and expectations will help guide the decision-making process. If surgery is deemed appropriate, it could potentially improve both the alignment of your eyes and your overall appearance.

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