Strabismus: Post-Surgery Concerns and Miscommunication

Q: Strabismus: Post-Surgery Concerns and Miscommunication

Hello： A general deviation of 4 degrees is quite difficult to assess, and the angle of deviation that is clearly significant enough to require surgery is usually much larger than four degrees. <br>However, if there is accompanying muscle paralysis or weakness, the situation is di

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My doctor said that due to nerve paralysis and weakness, my eyes still appear to be misaligned.
Did he previously mention 14 degrees? I thought I heard 4 degrees! I asked people around me to take a look, and it's obvious that my eyes have an inward strabismus, especially since I've been using screens a lot, which makes my eyes very fatigued.
My dad also mentioned that after the surgery, there was some improvement, but now it seems like the misalignment has returned a bit.
Could it be because I've been massaging my eyes? The original doctor is located in the southern part of the country, which is very far away, so I won't be going back for follow-ups.
However, I find it strange that the doctor initially said the misalignment would be unnoticeable after the surgery, but during the second follow-up, he mentioned that it was due to weakness and that unless my head is straight, it won't be obvious.
The doctor suggested a second surgery, but I'm worried about the precision and whether it might overcorrect the issue.
I didn't think much of it at first, but if the surgery was supposed to be very precise, why is it that others can still easily notice my strabismus? What do you mean by weakness? Didn't the surgery leave me with only 4 degrees?

Xie Shi, 20~29 year old female. Ask Date: 2014/10/25

Dr. Zhuang Yamin reply Ophthalmology

Hello: A general deviation of 4 degrees is quite difficult to assess, and the angle of deviation that is clearly significant enough to require surgery is usually much larger than four degrees.
However, if there is accompanying muscle paralysis or weakness, the situation is different.
In cases of muscle paralysis, the angle of deviation may vary when the eyes move to look in different directions.
I apologize for my limited understanding of your preoperative and postoperative eye conditions, making it challenging to provide an appropriate judgment or explanation.
I also worry that insufficient information could lead to misunderstandings.
I hope you can understand! The Ophthalmology Department of Changhua Hospital cares about you~

Reply Date: 2014/10/25

More Info

Strabismus, commonly known as squint or crossed eyes, is a condition where the eyes do not properly align with each other. It can be caused by various factors, including muscle imbalances, neurological issues, or even refractive errors. In your case, it seems that you have undergone surgery to correct this condition, but you are experiencing ongoing concerns about the alignment of your eyes post-surgery.

Firstly, it's important to understand that surgical correction of strabismus aims to realign the eyes by adjusting the muscles responsible for eye movement. However, the success of the surgery can vary based on several factors, including the underlying cause of the strabismus, the degree of misalignment before surgery, and the individual’s healing response.
From your description, it appears there may have been some miscommunication regarding the degree of strabismus you initially had. If your doctor mentioned a 14-degree misalignment and you thought it was 4 degrees, this discrepancy could lead to confusion about the expected outcomes of the surgery. It’s crucial to clarify these details with your healthcare provider to ensure you have a clear understanding of your condition and the surgical goals.

Post-surgery, it is not uncommon for patients to experience fluctuations in eye alignment. Factors such as muscle fatigue, overuse of digital devices, and even the natural healing process can contribute to these changes. Prolonged use of screens can lead to eye strain, which might exacerbate any existing misalignment. This is particularly relevant if you are using your eyes intensively for tasks like reading or using electronic devices, as it can lead to temporary changes in vision and eye alignment.

Regarding your concerns about the surgery's effectiveness, it’s essential to recognize that while many patients achieve significant improvement, some may still experience residual strabismus. This can be due to various reasons, including the complexity of the muscle adjustments required or the presence of underlying neurological issues, such as nerve palsy, which can affect muscle function. Your mention of "nerve weakness" suggests that there may be an underlying issue that could be contributing to the misalignment, which might not have been fully addressed during the initial surgery.

If your doctor has suggested the possibility of a second surgery, it’s likely because they believe there is still potential for improvement. However, it’s also important to weigh the risks and benefits of further surgical intervention. Each surgery carries its own risks, including the potential for overcorrection or undercorrection, which can lead to further complications.

In terms of managing your current symptoms, consider the following steps:
1. Follow-Up Consultation: If possible, seek a follow-up consultation with an ophthalmologist or a strabismus specialist. They can provide a thorough assessment of your eye alignment and discuss potential treatment options, including the possibility of a second surgery.

2. Limit Screen Time: Try to reduce the amount of time spent on screens, and take regular breaks to minimize eye strain. The 20-20-20 rule can be helpful: every 20 minutes, look at something 20 feet away for at least 20 seconds.

3. Eye Exercises: Depending on your specific situation, your doctor may recommend eye exercises to strengthen the eye muscles and improve coordination.

4. Monitor Symptoms: Keep track of any changes in your symptoms, including the degree of misalignment and any discomfort or fatigue. This information can be valuable for your healthcare provider.

5. Consider Vision Therapy: In some cases, vision therapy may be beneficial in conjunction with or instead of surgery. This therapy focuses on improving visual skills and coordination.

In conclusion, while it’s understandable to feel frustrated with the ongoing issues related to your strabismus post-surgery, it’s essential to communicate openly with your healthcare provider about your concerns. They can help clarify the situation and guide you toward the most appropriate next steps for your eye health.

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