Post-Strabismus Surgery: Managing Eye Alignment and Nerve Weakness

Q: Post-Strabismus Surgery: Managing Eye Alignment and Nerve Weakness

Hello, in response to your questions, here are the answers：<br>1) A postoperative residual angle of 4 degrees is considered a very successful surgery, and it may be difficult to assess with the naked eye. <br>Your perception of a significant tilt may be due to focusing on one eye

Post-strabismus surgery

I had surgery about a year ago, and the doctor said I have a remaining 4 degrees of deviation.
However, the doctor mentioned that I have nerve paralysis and weakness, so my eye still appears misaligned.
I feel that it is still quite tilted.
I would like to ask:
1) What causes the eye to become misaligned again, and how can I prevent it from becoming misaligned or tilted back?
2) If the eye tilts back, will my head also tilt back, or will it only be the eye that is misaligned?
3) I read online that people with esotropia should avoid gazing into the distance.
Is this misinformation, or is there a reason for this?
4) Can I use massage around my eyes and eye exercises to prevent the misalignment or to strengthen the weakened nerves?

xie shi, 20~29 year old female. Ask Date: 2014/10/21

Dr. Zhuang Yamin reply Ophthalmology

Hello, in response to your questions, here are the answers:
1) A postoperative residual angle of 4 degrees is considered a very successful surgery, and it may be difficult to assess with the naked eye.
Your perception of a significant tilt may be due to focusing on one eye at a close distance.
It is recommended that you evaluate your condition with a photograph taken from a distance for a more accurate assessment.
Additionally, the typical postoperative deviation when "the line loosens" is usually much more pronounced, often greater than 4 degrees, which is entirely different from your situation.
Furthermore, if your muscle nerves are paralyzed, your eye position may vary depending on the angle of observation, so please communicate thoroughly with your surgeon during your follow-up visit.
2) To clarify again: a residual deviation of 4 degrees indicates a very successful surgery, so it should not be referred to as "returning to strabismus." This degree of deviation is minimal and is unlikely to cause compensatory head tilting.
3) When looking at near objects, the eyes naturally tend to converge slightly, making esotropia less noticeable.
Conversely, esotropia becomes more apparent when looking at distant objects, but it does not worsen due to distance.
This is similar to how a green bug is less visible on green leaves but stands out clearly on dry leaves; it is not that the bug becomes greener on the dry leaves, but rather the contrast is more pronounced.
4) The paralysis of the muscle nerves varies depending on factors such as the extent of injury, the cause, and the duration.
Nutritional support for nerve repair can aid recovery.
However, eye massage has limited effectiveness, and eye exercises typically target the medial rectus muscle for convergence exercises, which are intended for patients with exotropia.
If you have esotropia, these exercises would not be appropriate.
Changhua Hospital, Ophthalmology Department, cares about you.

Reply Date: 2014/10/21

More Info

Post-strabismus surgery management can be quite complex, especially when dealing with residual misalignment and nerve weakness. Your concerns about the potential for your eyes to revert to their previous state, as well as the implications for your head position, are valid and warrant a thorough discussion.

1. Preventing Eye Misalignment: After strabismus surgery, it is not uncommon for patients to experience some degree of residual misalignment. The muscles that control eye movement can become weak or imbalanced due to nerve issues, which may lead to a return of strabismus. To prevent further misalignment, it is crucial to follow your ophthalmologist's recommendations closely. This may include wearing prescribed glasses, engaging in vision therapy, and performing specific eye exercises. Regular follow-ups with your eye care provider are essential to monitor your condition and make adjustments to your treatment plan as necessary.

2. Head Positioning: If your eyes do misalign again, it is possible that your head may tilt or turn to compensate for the misalignment. This is a common adaptive behavior in individuals with strabismus, as the brain attempts to achieve better visual alignment and reduce double vision. If you notice that your head is tilting or turning, it is important to address this with your eye care provider, as it may indicate a need for further intervention.

3. Viewing Habits: The advice regarding avoiding certain viewing habits, such as gazing into the distance, is often based on the idea that certain positions can exacerbate muscle imbalances or strain the eyes. However, this advice can vary depending on individual circumstances. It is essential to discuss your specific situation with your ophthalmologist, as they can provide tailored recommendations based on your condition and recovery progress.

4. Eye Exercises and Massage: Engaging in eye exercises and gentle massage around the eyes can be beneficial in some cases. These practices may help improve muscle tone and coordination, potentially aiding in the recovery of nerve function. However, it is crucial to approach this under the guidance of a healthcare professional. They can provide you with specific exercises that are safe and effective for your condition. Overdoing it or performing incorrect exercises could lead to further complications.

In summary, managing post-strabismus surgery symptoms involves a multifaceted approach that includes regular monitoring, adherence to prescribed treatments, and possibly engaging in eye exercises. Your concerns about eye alignment and nerve weakness are valid, and addressing them with your healthcare provider will be key to achieving the best possible outcome. Remember that recovery can take time, and patience is essential as you work towards improving your eye alignment and overall visual function.

Similar Q&A

Improving Double Vision After Strabismus Surgery: Tips and Techniques

I just had strabismus surgery; I have alternating strabismus with an angle of about 50-55 degrees. After the surgery, the doctor advised us to perform eye exercises, but I am unable to achieve binocular focus. Whenever one eye is aligned, the other tends to drift. I would like to...

Dr. Gao Pilin reply Ophthalmology
Hello: After undergoing strabismus surgery, the recovery of eye movement is an important phase. It is normal to experience some discomfort during this stage, but the situation should gradually improve over time. The difficulty in achieving binocular focus that you are currently d...

Post-Operative Challenges After Strabismus Surgery: Seeking Solutions

About three years ago, I underwent surgery. For the first year or two, I felt great and my eyes were very strong. However, now I feel that the muscles are becoming increasingly weak, and my double vision is getting worse, especially when looking to the sides. Initially, only my r...

Dr. Gao Pilin reply Ophthalmology
Hello: 1. Ophthalmic Examination: First, you should consult an ophthalmologist as soon as possible, especially the surgeon who performed your previous procedure, to understand your current condition and the specific reasons for your issues. The physician needs to assess your visu...

Post-Surgery Diplopia: Solutions and Treatments for Eye Muscle Issues

Dear Dr. Ke, Hello. I have a question regarding exophthalmos caused by thyroid disease, which has resulted in diplopia following orbital surgery. Are there any instruments currently available to correct the issue of diplopia? For young children with strabismus, glasses are used ...

Dr. Ke Meilan reply Ophthalmology
Hello Ms. Yeh: For your diplopia, you may consider wearing prism glasses. This issue of diplopia is indeed due to limited and uncoordinated muscle activity. If there is no improvement four months after surgery, then we can consider prism glasses. Personally, I believe that diplop...

Effective Vision Training After Strabismus Surgery: Tips and Techniques

Hello, I am 26 years old. After undergoing surgery for strabismus in my left eye, my doctor advised me to cover my eye for vision training and to return for a follow-up appointment in about a week. The doctor mentioned that my eye movement is minimal and suggested that I need to ...

Dr. Wang Zhishun reply Ophthalmology
Hello: Regarding the situation described in your letter, I must admit that I am not very clear about it. Generally, after strabismus surgery, vision therapy is required for children due to amblyopia caused by strabismus. If the patient is already an adult, the primary purpose of ...