Squint Surgery in Adults

This information aims to answer some of the questions you may have about squint surgery. However, it does not cover everything as every patient and squint is different. Your surgeon will discuss your particular case with you. Please ask the clinical staff about anything you want to be made clear.

What is the aim of surgery?

  • To improve the alignment of the eyes, to make the squint smaller in size.
  • In some patients, to reduce or try to eliminate double vision.
  • Occasionally to improve an abnormal position of the head.

How is the surgery done?

Squint surgery is a very common eye operation. It usually involves tightening or moving one or more of the outside eye muscles which move the eye. These muscles are attached quite close to the front of the eye under the conjunctiva, the clear surface layer. The eye is never taken out of the socket during surgery. Stitches are used to attach the muscles in their new positions.
Squint surgery is nearly always a day case procedure so you should be in and out of hospital on the same day.
There are two kinds of squint operation – adjustable and non-adjustable:

Non adjustable surgery

The operation is usually carried out under general anaesthetic. The operation usually takes up to 60 minutes depending on the number of muscles that need surgery. When you have recovered from the anaesthetic and the nurses are happy for you to be discharged, you are free to go home – usually a few hours later.

Adjustable surgery

Squint surgery using an adjustable suture may give a better result in certain types of squint e.g. patients who have had a squint operation before, patients with a squint due to injury or patients with thyroid eye problems.

Part 1 – The main operation

The main part of the operation is carried out in the operating theatre usually under general anaesthetic (with you asleep).

Part 2 – Adjusting the stitch

Once you have woken up from the anesthetic the final position of the muscles is adjusted when you are awake and able to look at a target. This is particularly useful for treating double vision. If you wear glasses for distance or near, these will need to be brought in with you for this part of the operation. Adjustment is usually done on the ward, after drops of anaesthetic have been put into the eye to take away any pain. You may however feel a pressure sensation.

Before the day of surgery

A pre-assessment is performed in the weeks leading up to the operation date.

What happens on the day of surgery?

You will be asked to come early so that you can be prepared for surgery. You should not drink or eat before the operation: the exact timings of this will be given before the day of the operation. Before being discharged after the operation, you will receive eye drops with instructions and a follow up appointment.

Does the surgery cure the squint?

Overall about 90% patients feel some improvement in their squint after surgery. The amount of correction that is right for one patient may be too much or too little for another with exactly the same size squint, so that the squint may not be completely corrected by the operation. Although the eyes may be straight just after surgery, many patients require more than one operation in their lifetime. If the squint returns it may drift in either the same or opposite direction. We can’t predict when that drift may occur.

What are the risks of the operation?

Squint surgery is generally a safe procedure. However, as with any operation, complications can and do occur. Generally these are relatively minor but on rare occasions they may be serious.

  • Under and overcorrection

As the results of squint surgery are not completely predictable, the original squint may still be present (undercorrection) or the squint direction may change over (overcorrection). Occasionally a different type of squint may occur. These problems may require another operation.

  • Double vision

You may experience double vision after surgery, as your brain adjusts to the new position of the eyes. This is common and often settles in days or weeks but may take months to improve. Some patients may continue to experience double vision when they look to the side in order to achieve a good effect when the eyes look straight ahead. Rarely, double vision whilst looking straight ahead can be permanent in which case further treatment might be needed. If you already experience double vision, you might experience a different type of double vision after surgery. Botulinum toxin injections are sometimes performed before surgery to assess your risk of this.

  • Allergy/stitches

Some patients may have a mild allergic reaction to the medication they have been prescribed after surgery. This results in itching/irritation and some redness and puffiness of the eyelids. It usually settles very quickly when the drops are stopped. You may develop an infection or abscess around the stitches. This is more likely to occur if you go swimming within the first four weeks after surgery. A cyst can develop over the site of the stitches, which occasionally needs further surgery to remove it.

  • Redness

The redness in the eye can take as long as 3 months to go away. Occasionally the eye does not completely return to its normal colour, particularly with repeated operations.

  • Scarring

Most of the scarring of the conjunctiva (skin of the eye) is not noticeable by three months, but occasionally visible scars will remain, especially with repeat operations.

  • Lost or slipped muscle

Rarely one of the eye muscles may slip back from its new position during the operation or shortly afterwards. If this occurs, the eye is less able to move around and, if severe, further surgery can be required. Sometimes it is not possible to correct this. The risk of slipped muscle requiring further surgery is about 1 in 1,000.

  • Needle penetration

If the stitches are too deep or the white of the eye is thin, a small hole in the eye may occur, which may require antibiotic treatment and possibly some laser treatment to seal the puncture site. Depending on the location of the hole, the sight may be affected. The risk of the needle passing too deeply is about 2%.

  • Anterior segment ischaemia

The blood circulation to the front of the eye can very rarely be reduced following surgery, producing a dilated pupil and blurred vision. This usually only occurs in patients who have had multiple surgeries. The risk is about 1 in 13,000 cases.

  • Infection

Infection is a rare complication but the risk  increases if drops are not instilled as directed and treatment not sought promptly. Significant infection is extremely rare but in the worst cases can cause loss of vision or the eye (endophthalmitis, orbital cellulitis).

  • Loss of vision

Although very rare, loss of vision in the eye being operated can occur from this surgery. Risk of serious damage to the eye or vision is approximately 1 in 30,000.

  • Anaesthetic risks

Anaesthetics are usually safe but there are small and potentially serious risks. Unpredictable reactions occur in around 1 in 20,000 cases and unfortunately death in around 1 in 100,000.
Remember: these complications are detailed for your information and that the vast majority of people have no significant problems. After the operation the eye(s) will be swollen, red and sore and the vision may be blurry. The eye may be quite painful.
Start the drops you have been prescribed that evening, and painkillers such as paracetamol and ibuprofen can be taken. The pain usually wears off within a few days. The redness and discomfort can last for up to 3 months particularly with adjustable and repeat squint operations.
You should not sign any legal documents or drive for 48 hours after the general anaesthetic.
We would advise that you may need one or occasionally two weeks off work. Work and normal activities including sport can be resumed as soon as you feel comfortable to do so. It is quite safe to use the eyes for visual tasks, for example reading, watching television. You should return for follow up as advised.

Summary of care after the operation

  • Use the eye drops
  • Use painkillers such as paracetamol and ibuprofen if the eyes are painful
  • Use cooled boiled water and a clean tissue or cotton wool to clean any stickiness of the eyes and avoid water entering the eyes from the bath or shower for the first two weeks
  • Don’t rub the eye(s) as this may loosen the stitches
  • No swimming for 4 weeks
  • Attend the postop clinic appointment
  • Continue using glasses if you have them
  • Avoid contact lens wear in the operated eye(s) until advised it is safe by the doctor or orthoptist

Selective Laser Trabeculoplasty

Selective Laser Trabeculoplasty (SLT) is a procedure used to reduce the pressure in the eye (also known as intra-ocular pressure). A laser beam is applied to the drainage channels, which helps to unclog them. This means the aqeous humour flows through the channels better, reducing the pressure in the eye. This is not a permanent treatment, and may need to be repeated in the future to control the eye pressures adequately. The procedure does not require admission to hospital and is carried out in the outpatients department.

Refractive Surgery

Most refractive errors can be corrected (or at least improved) by means of Refractive Surgery. This is a generic term, which comprises both Laser Refractive Surgery and correction by means of lens implants inside the eye. The latter is called Phakic intraocular lens (IOL) surgery.
Most refractive errors can be corrected (or at least improved) by means of Refractive Surgery. This is a generic term, which comprises both Laser Refractive Surgery and correction by means of lens implants inside the eye.

Posterior Vitreous Detachment

PVD is a common degenerative change, which affects one or both eyes in many people after middle age. It may present earlier in shortsighted patients or those who have sustained traumas to the eyes.
Thickening of the jelly casts shadows on the retina and are seen as floating shapes. These black “floaters”in your vision move with the eye and then settle as the eye rests. These are often described by patients as a “cobweb” or “insects”.
You may also be aware of flashing lights, like little flickers in the outer periphery. Usually these do not highlight a problem, however, it is important to have the eye thoroughly checked, as occasionally a retinal tear or a retinal detachment may occur.

Post-Operative Instructions

Following Retinal Surgery on leaving the hospital you are advised to have a quiet evening at home and to avoid strenuous exercise.
For General Anaesthetic patients, as above and:

  • Do not drive a vehicle
  • Do not make any crucial financial decision
  • Do not eat heavy meals or drink alcohol for 24 hours after being discharged

Lacrimal Probing in Children

The tear duct is a channel/passage which runs from a tiny opening in the medial lids through the bone to the inside of the nose, and drains the tears and mucus the eye produces. It should open just before or just after birth but sometimes remains blocked for a considerable time after that, causing watering and discharge from the eye. It is harmless, and does not affect the health of the eye or the vision, although it can make the eyelids red and sore and slightly increases the frequency of infective conjunctivitis.

Diabetic Retinopathy

Introduction

  • Diabetic retinopathy is a complication of diabetes and leads to high blood sugar, resulting in retinal disease, which can interfere with its ability to transmit images to the brain through the optic nerve.
  • Blood vessels in the retina play an important role in supplying it with oxygen and nutrients, which keep it healthy and working effectively.

Diabetic Retinopathy can result in damage to the blood vessels; these may then bleed, leak or become blocked leading to cell damage in the retina itself.
There are varying forms and levels of severity of diabetic retinopathy – for example, when the retina becomes very damaged, new blood vessels may grow on it and can burst, leading to bleeding and blurred vision. If the macula (the central area of the retina) is affected – this is called Diabetic Maculopathy – the disease has reached a much more advanced and serious stage.
High blood pressure combined with diabetes leads to an even more dangerous condition.

Types of Diabetic Retinopathy

Non Proliferative Diabetic Retinopathy
Generally, this type of diabetic retinopathy does not affect vision because at the initial stage there are just a few enlarged blood vessels, with very minimal bleeding and leaking in the retina.
An examination of the retina by an ophthalmologist will reveal some marks indicating the presence of the condition.
Proliferative Diabetic Retinopathy
This condition can lead to seriously impaired vision as blood vessels grow in the retina and the threat is bleeding from these vessels which can lead to retinal damage, and even to retinal detachment at the back of the eye. Laser treatment is essential to avoid serious long term damage.
Diabetic Maculopathy
Diabetic maculopathy occurs when blood vessels leak into the central area of the retina, which can lead to it swelling and affecting the quality of vision. Laser procedures, injections or surgery are the main treatment options.
Exudates are deposits in the retina from leaky vessels. Haemorrhages in the retina of varying sizes.
Microaneurysms.
Optic Nerve with abnormal new vessels that have bled. Scars from previous laser treatment.
Vitreous haemorrhage in front of the retina.
End stage proliferative Diabetic Retinopathy with fibrousbands.
Retinal Detachment.
Cross sectional scan showing thickening of the macula and exudates.
Exudates (yellow) and haemorrhages in the central retina

Can it be prevented?

Compliance with treatment for diabetes helps control blood sugar levels and blood pressure and so the serious complications of diabetes, including diabetic retinopathy.
Treatment compliance along with regular check ups to monitor blood pressure will help avoid the serious long term effects of diabetes; positive lifestyle choices from balanced diet to regular exercise and not smoking all have a beneficial effect.

What can I do?

Early diagnosis and treatment of diabetes and diabetic retinopathy will generally help prevent serious vision loss for most patients and regular visits to the doctor and ophthalmologist are an essential part of the monitoring process.

Dacryocystorhinostomy

[:en]Blocked Tear Duct. The tear ducts start at the inner corner of the eye with two small holes in the corner of the eyelids. Each hole is known as a punctum, they lead into small tubes known as canaliculi, which in turn drains into the lacrinal sac. This lies between the corner of your eye and your nose which has a duct at the bottom, which drains into your nose, which drains nasolacrimal duct. They continue into small channels that join up and reach the lacrimal sac, which leads into the nasolacrimal duct. The tear ducts do not have much spare capacity and this is why we cry. The channels tend to become narrower with age, especially if there has been nose or sinus disease. An obstruction of the tear ducts will give you a watery eye. Syringing of the lacrimal system with a blunt cannula will determine the type and the site of the blockage. Occasionally a special radiograph is necessary. Called a dacrocystogram, which visualizes the locrimal duct at the eye following the injection of an x-ray dye into the duct.
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Return to Educational Leaflets Homepage[:ar]الوقائع:

  • تنطلق الأقنية الدمعية من ثقبين صغيرين في الزاوية الداخلية للعينين ثم تنضم إلى الكيس الدمعي لتبلغ بعده القناة الأنفية الدمعية.
  • إنّ القنوات الدمعية قليلة السعة وهذا ما يجعلنا نبكي. كما أنها تضيق مع التقدم في السن.
  • خاصّة لدى الإصابة بإلتهاب الجيوب الأنفية.
  • يؤدي انسداد الأقنية الدمعية إلى تدمع العينين.
  • إن إدخال قُنَيّة (أنبوب) كليلة (غير حادة) إلى الجهاز الدمعي من شأنه تحديد موقع الإنسداد.
  • في بعض الحالات يتم اللجوء للتصوير الشعاعي الخاص.

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Amblyopia therapy information leaflet

What is Amblyopia?

Lazy eye – the medical term is Amblyopia – is a common eye condition amongst younger children. It means that one eye is not developing properly and becomes ‘lazy’ because the brain is working harder with the good eye to compensate. The problem is that if the brain ignores the lazy eye, the cells in the brain that create vision do not develop properly. Generally, Amblyopia affects just one eye but sometimes both eyes can have a problem.

What causes a ‘lazy eye’?

For children, the most important period for the development of vision is from birth to the age of 6 and if there is any interference with development during this period, then this can lead to amblyopia which is commonly caused by a squint (strabismus) in one eye, anisometropia (different vision/prescriptions in each eye), and/ or obstruction of an eye due to cataract, trauma, lid droop, etc.

Why does my child need to wear a patch?

The best and simplest way to treat lazy eye is to cover or patch (known as occluding) the other eye so the vision in the lazy eye can improve and develop the pathways to the brain.
The patch is worn over the good eye and the amount of time the patch must be worn is decided by the Orthoptist/Ophthalmologist and relates to the extent of the visual problem.
With early treatment by patching, vision can develop successfully but this becomes more difficult with older children and the level of vision achieved may not be as good.

Ophthalmologist

[:en]Patients who need further specialist treatments for their eyes go to an Ophthalmologist. An Ophthalmologist is a medical doctor who specialises in the medical and surgical care of the eyes, visual system and in the prevention of eye diseases and injuries.
They provide the full range of care including routine eye examinations, diagnosis and treatment of eye disorders and diseases, including prescriptions for eyeglasses, medications, surgery, and management of eye problems that are caused by systemic illnesses.
An ophthalmic eye examination might include history (general, family, medications, allergies…etc), examination of the vision acuity (clarity and sharpness), physical examination, and focimetry (assessment of spectacles) depending on the patient case.
In addition, an Ophthalmologist can specialise in specific areas of eye care such as glaucoma, cornea, oculoplastic (abnormalities which mainly affect the function and aesthetics of, the eyelids and lacrimal system), paediatric ophthalmology (including genetic abnormalities including crossed eyes and lazy eyes), and diseases that affect the retina – a tissue that lines the inner surface of the eye.
Click here to read more on our Optomertists
To visit Examinations Image Library click here
To read more on Parents and Children, click here

[:ar]يزور المريض أخصائي طب العيون إذا احتاج إلى علاج أكثر تخصصاً. أخصائي طب العيون هو طبيب يتخصص في الرعاية الطبية والجراحية للعيون وجهاز الإبصار وفي الوقاية من أمراض وإصابات العيون.
ويقدم أخصائي طب العيون طيفاً متكاملاً من خدمات الرعاية الصحية، بما في ذلك فحوصات العين الدورية، وتشخيص وعلاج اضطرابات وأمراض العيون، بما في ذلك وصف النظارات الطبية والأدوية والجراحة وإدارة الحالات وأمراض العيون الناتجة عن أمراض أخرى.
قد يتضمن فحص العيون لدى أخصائي طب العيون مراجعة للتاريخ الطبي (التاريخ الصحي عموماً والتاريخ العائلي والأدوية المستخدمة والحساسيات وما إلى ذلك)، وفحص دقة الإبصار (الوضوح وحدة النظر)، وفحص يدوي وتقييم للعدسات المستخدمة (focimetry) وذلك بحسب حالة المريض.
وبالإضافة إلى ما سبق، قد يتخصص طبيب العيون في مجالات محددة من طب وصحة العيون مثل الجلوكوما والقرنية والجراحة التجميلية للعيون (وهي علاج لتشوهات تؤثر على وظيفة ومظهر جفن العين ونظام تصريف الدمع) والأمراض التي تؤثر على شبكية العين – وهي النسيج المبطّن لسطح العين الداخلي.
لزيارة مكتبة الصور الامتحانية اضغط هنا.
لقراءة المزيد عن الآباء والأطفال ، انقر هنا.
لزيارة موظفي القسم انقر هنا.[:]

Orthoptist

[:en]Children who need to see an eye Specialist will initially go for a review with an Orthoptist – a health professional who specialises in eye movement problems and disorders that affect how the eyes work together.
These conditions are typically diagnosed in childhood; so Orthoptists are highly experienced in examining children of all ages and they play a central role in the evaluation and treatment of childhood eye disorders.
It is the Orthoptist who comes to school to do the vision screening of pupils. In an orthoptic examination, an Orthoptist will perform an assessment which includes checking for vision clarity (20/20, 20/40 vision…etc), whether eyes are functioning and moving together and detecting any abnormal conditions such as lazy eyes.
Orthoptists are not medical doctors but are highly skilled Specialists.
Patients who go to an Optometrist to be checked for glasses; an Orthoptist to examine a lazy eye; or an Ophthalmologist to perform laser eye surgery, all have one thing in common. They benefit from a team of eye care Specialists that work closely together to help maintain good eye health and provide skilled diagnoses and treatment when needed.
To visit Examinations Image Library click here
To read more on Parents and Children, click here[:ar]عندما يحتاج الأطفال زيارة أخصائي للعيون فإنهم في البداية يزورون أخصائي تقويم النظر – وهو مختص في تشخيص مشاكل واضطرابات حركة العين التي قد تؤثر على عمل العينين معاً.
ويتم عادة تشخيص هذه المشاكل في مرحلة الطفولة، وهذا يعني أن أخصائي تقويم النظر يملك خبرة واسعة في فحص الأطفال من مختلف الأعمار، ويلعب دوراً أساسياً في تقييم وعلاج اضطرابات العيون لدى الأطفال.
أخصائي تقويم النظر هو الشخص الذي يزور المدارس لفحص عيون الطلاب. ويقوم أخصائي تقويم النظر في أثناء فحص العين بتقييم مدى وضوح الرؤية (قياس النظر 20/20 أو 20/40، …) وما إذا كانت وظائف العيون سليمة، وما إذا كانت العينان تعملان بشكل متناسق معاً، كما يحاول الكشف عن أي مشاكل في العين مثل العين الكسولة.
أخصائي تقويم النظر ليس طبيباً لكنه أخصائي متمرس ومؤهل.
المرضى الذين يزورون أخصائي فحص النظر لتركيب نظارات طبية، أو أخصائي تقويم النظر لفحص العين الكسولة، أو أخصائي طب العيون لإجراء عملية تصحيح البصر بالليزر – جميعهم يشتركون في أمر واحد. فهم يستفيدون من خبرات فريق متكامل من أخصائيي صحة العيون يعملون معاً بهدف الحفاظ على صحة العيون وتقديم خدمات التشخيص والعلاج لمن يحتاجها.
لزيارة مكتبة الصور الامتحانية اضغط هنا.
لقراءة المزيد عن الآباء والأطفال ، انقر هنا.[:]

Optometrist

[:en]Patients who need to have a vision test or have glasses/contact lenses fitted to correct their vision, go to an Optometrist. An Optometrist is a health care professional who is licensed to provide primary eye care services.
Optometrists examine and diagnose vision defects such as near sightedness, farsightedness, astigmatism (blurred vision), and presbyopia (reduced ability to focus on close objects) among other possible problems.
During an optometric examination, vision abnormalities can be found. So, Optometrists can recommend treatments for patients including prescriptions for eyeglasses, contact lenses, low vision aids, medications or a referral to an Ophthalmologist for advanced medical, surgical or laser treatment.
The Optometrist can also perform minor surgeries such as removing a foreign object from the surface of the eye.
To visit Examinations Image Library click here
To read more on Parents and Children, click here[:ar]يلجأ المرضى لأخصائي فحص النظر إذا كانوا يحتاجون لإجراء فحص للبصر أو لتركيب نظارات/عدسات طبية لاصقة لتصحيح البصر.أخصائي فحص النظر هو أحد أخصائيي الرعاية الصحية وهو مؤهل وحاصل على رخصة لتقديم خدمات الرعاية الصحية المتعلقة بفحص العيون.
يقوم أخصائيو فحص النظر بفحص وتشخيص أي خلل في قدرة الإبصار مثل قصر النظر وطول النظر واللابؤرية (تشوش الرؤية) وطول النظر المرتبط بالشيخوخة (أو ضعف القدرة على التركيز على الأجسام القريبة) وغيرها من المشاكل المحتملة.
قد يكشف أخصائي فحص النظر عن مشاكل أو خلل في النظر أثناء الفحص. وفي هذه الحالة يمكن لأخصائي فحص النظر التوصية بالعلاج المناسب للمريض بما في ذلك وصف ارتداء النظارات الطبية أو العدسات اللاصقة أو استخدام أدوات تقوية النظر أو الأدوية، أو تحويله إلى أخصائي طب العيون للحصول على علاج متقدم ومتخصص؛ طبي أو جراحي أو ليزري.
ويمكن لأخصائي فحص النظر إجراء جراحات بسيطة مثل إزالة جسم غريب من سطح العين.
انقر هنا لقراءة المزيد عن أخصائيوا النظارات.
لزيارة مكتبة الصور الامتحانية اضغط هنا.
لقراءة المزيد عن الآباء والأطفال ، انقر هنا.[:]