Advice after your nerve block for surgery
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Introduction
A squint is a misalignment of the eyes which may be constant or intermittent.
Some squints may be partially or completely corrected by glasses. If the squint is corrected with glasses, it will still be noticeable without glasses. In this situation, it is often not possible to make the eyes straight both with and without glasses.
The aim of squint surgery is usually to improve the appearance of the eye alignment; or to help patients use both eyes together; or to alleviate double vision. It can be performed on one or both eyes.
In children, a squint operation will only be considered once the glasses are worn well and once the patching treatment, if required, has improved the sight maximally. The consultant ophthalmologist will discuss with you the pros and cons of squint surgery and, if appropriate, will place your name on the waiting list. The Eye Surgery Bookings Office will be able to give you an approximate waiting time.
Not all squints are suitable for surgery. The orthoptist and ophthalmologist will discuss this with you if surgery is an option.
What does the surgery involve?
Surgery does not involve ‘taking the eye out’.
In squint surgery, muscles that move the eye are either weakened or tightened. These muscles are easily reached as they are exposed by lifting the conjunctiva (a transparent layer on the white of the eye). The muscles are secured into position by dissolvable stitches and the conjunctiva is replaced.
The predicted outcome from squint surgery is not always fully achieved. Some may need a further operation for their squint; this may be soon, or many years after the original surgery. Sometimes the nature of the squint is such that it will take more than one operation to correct it.
Pre-operative assessment
You will be asked to attend for a pre-operative assessment: Children and adults attend the orthoptic department, where further measurements of the squint are made and a discussion of the planned operation will take place.
A post-operative appointment is confirmed, generally for 1 week after surgery. Adults will also have another appointment with the nurse for some general health tests. For children these tests are performed on the day of surgery.
On the day of the operation - children / teenagers
If your child / teenager has a severe cough or chest infection, please postpone the surgery. Your child / teenager will be admitted on the day of the operation to either the day surgery unit or F1, the children’s ward, which also has a teenage unit. You will be sent advice about when to stop him / her eating and drinking. He / she is assessed by the eye doctor and anaesthetist to ensure that surgery may go ahead. Please ask the anaesthetist if you would like to accompany your child to the anaesthetic room.
Ward F1 - 0300 613 4252 and ask for Ward F1
Day surgery Unit - 0300 614 5000 extension 133260
On the day of the operation - adults
Adults are admitted to the day surgery unit and they will be seen by the anaesthetist and eye doctor on the day to ensure surgery may go ahead.
The operation
Squint surgery is usually performed under general anaesthetic (with the patient asleep). Occasionally this may be performed under local anaesthetic – in adults only.
It normally takes approximately 1 hour although it may be longer. Almost all patients go home the same day of the operation, after being assessed by the doctor, nurse and / or orthoptist and having eaten food and passed water.
Adjustable sutures - adults only
Your surgeon may advise a type of surgery where a small adjustment can be made on the day of surgery once you are awake. This can be the best way to ensure a good result. The operation is done, whilst you are under the general anaesthetic, as normal, but one stitch is left in a bow rather than being tied in a knot. When you are awake the eye is numbed with eye drops. If an adjustment is needed the stitch may be loosened or tightened.
After the operation
Occasionally, following surgery, there is a period of double vision due to the new alignment of the eyes, in the majority of cases this gradually resolves. The eye may be red and gritty for a few weeks following surgery and the lids may be a little swollen for a few days. The eye is not usually painful. The redness of the eyes will reduce over time. This can take weeks and varies from person to person and is usually worse in an eye that has previously had surgery.
Sometimes, a fine ridge can be seen on the white of the eye (this is equivalent to an operation scar elsewhere on the body). This gradually becomes less visible.
You will be given drops to instil in your eye after surgery. These will soothe the eyes and reduce the inflammation (redness) and decrease the risk of infection. Please use them for 2 to 3 weeks after surgery, depending on the redness.
Advice after the operation
If you have been carrying out patching treatment, this should be stopped from the day of the operation until the next appointment with the orthoptist, who will then advise if it needs to be restarted.
Glasses should be worn as before the operation (unless otherwise advised) as squint surgery does not affect vision or the need for glasses.
If the eye is slightly sticky you can use a clean piece of cotton wool and boiled water that has been left to cool to clean the eyelids. Wipe gently from the nose outwards then discard the cotton wool and repeat as necessary. Use separate cotton wool for each eye.
The alignment of the eyes may vary and may not settle for a few weeks. Children should has 1 week off school and adults 1 week off work.
Swimming should be avoided for 3 weeks after surgery. Sports and activities which could result in a direct blow to the eye should also be avoided for 3 weeks.
Possible complications of the operation
- Obvious under or overcorrection of the squint - this may require further surgery or botulinum toxin injection.
- The dissolvable stitches can cause excess inflammation and rarely result in a lump.
- Allergic reaction to the eye drops - results in a red eye and surrounding skin.
- Double vision or deterioration of existing double vision. Recurrence of the squint, usually after some years, more common if there is no binocular vision.
- The eye may turn in or out in horizontal squints or up or down in vertical squints.
Rare severe complications
These only affect 1 - 10 in 10,000 patients:
- One per 2,400 operations leads to a poor or very poor outcome.
- A needle penetrating the eye (8 in 10,000) - although true incidence may be greater. This may rarely result in retinal detachment, infection or scleritis and loss of sight.
- Slippage of the eye muscle after the operation (7 in 10,000) in children this commonly results in a poor clinical outcome.
- Infection (6 in 10,000) - may result in slipped muscle.
- Scleritis (2.5 in 10,000) - inflammation of the white of the eye. Very rare in children and may be severe and prolonged with loss of sight.
- Slippage of the eye muscle during the operation (2 in 10,000) - More common in adults and may require further surgery.
*Statistics from British Ophthalmic Surveillance Unit - Survey of 24,000 squint operations in the UK*
If you are at all concerned or the eye does not seem to be improving after squint surgery, please contact the orthoptic department by calling 0300 613 4253. You can also phone the ward where you were an inpatient with any queries.
You can also contact the eye treatment centre on the following numbers if you have serious concerns:
| From 9am to 5pm Monday to Friday: | 0300 373 5884 |
| From 5pm to 9am and at weekends: | 0300 614 5000 and ask for the eye doctor on call |
Contact us
If you have any queries relating to this information, please contact the Ophthalmology service.
About this information
Service:
Ophthalmology
Reference:
QQ/016
Approval date:
2 August 2024
Review date:
1 July 2027
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.