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Preparing for squint surgery

Before surgery:
  • You'll attend a pre-operative assessment – some simple tests will be done to check that you can have the operation and you'll have the chance to ask any questions about it
  • You'll be told when to come into hospital for the procedure and when you should stop eating and drinking beforehand
  • You'll need to sort out how you'll be getting home – you can usually go home the same day, ideally with a friend or family member to escort you (as you may be sleepy); you won't be able to drive for at least a day or two if you've had surgery

What happens during squint surgery

Squint surgery is done under general anaesthetic (where you're asleep) and usually takes less than an hour. You or your child can usually go home the same day.

If your child is having surgery, you'll be able to accompany them into the operating room and stay with them until they've been given the anaesthetic.

During the procedure:

  • The eye is held open using an instrument called a lid speculum – sometimes it may be necessary to operate on both eyes to get the alignment right
  • The surgeon detaches part of the muscle connected to the eye and moves it into a new position so that the eyes point in the same direction
  • The muscles are fixed in their new position with dissolvable stitches – these are hidden behind the eye so you won't be able to see them afterwards

Sometimes, in adults and teenagers, further adjustments to your eye muscles may be made when you've woken up after the operation. Local anaesthetic eye drops are used to numb your eyes for this.

After squint surgery

Following the operation, a pad may be put over the treated eye. This is usually removed the next day, or sometimes before you go home.

The eye is likely to be sore for at least a few days. You may be given painkillers to reduce discomfort and some eye drops to help with healing.

You may experience some of the following side effects:

  • Eye pain – this tends to last at least a few days and often feels like grit or sand in the eye; taking simple painkillers such as paracetamol can help, although children under 16 shouldn't be given aspirin
  • Red eyes – this can last for a couple of months; you may also have blood in your tears for a day or two
  • Itchy eyes – this is caused by the stitches and it may last a few weeks until they dissolve; try not to rub your eyes
  • Double vision – this usually passes after a week or so, but can last longer

You'll be asked to attend follow-up visits with an eye specialist after surgery. Contact them, the hospital or your GP if you have any severe or lasting side effects from surgery.

Returning to normal activities

It can take several weeks to fully recover from squint surgery.

Your doctor or care team can give you specific advice about when you can return to your normal activities, but generally speaking

  • You can read or watch TV and carry out other daily activities as soon as you feel able to
  • You can return to work or school after about a week
  • Don't drive for at least a day or two (as the anaesthetic may not have fully worn off), or for longer if you have double vision
  • Try not to get any soap or shampoo in the eye when washing
  • Most people return to exercise and sport after about a week, although you may asked to avoid swimming and contact sports (such as rugby) for two to four weeks
  • Don't use make-up close to the eyes for four weeks
  • Your child shouldn't play in sand or use face paint for two weeks

If you wore glasses before surgery, you'll probably still need to wear them. But don't wear contact lenses until you're told it's safe to do so.

Risks of squint surgery


As with any kind of operation, there's a risk of complications after surgery to fix a squint. Serious complications are estimated to occur in 2 to 3 in every 1,000 procedures.

Risks include:

  • Further surgery being needed to fully correct the squint – this is quite common, particularly if the squint is severe
  • Permanent double vision – this may require special glasses to correct your vision (read more about how double vision is treated)
  • An infection, abscess (build-up of pus) or cyst (build-up of fluid) around the eye – this may require treatment with antibiotics and/or a procedure to drain the pus or fluid
  • The eye muscles slipping out of position – further surgery may be needed to correct this
  • A small hole being made in the eye as the eye muscles are stitched in place – this may require antibiotics to prevent infection and a procedure to close the hole
  • Loss of vision – this is very rare

Amblyopia

Amblyopia, also called lazy eye, is a disorder of sight due to the eye and brain not working well together. It results in decreased vision in an eye that otherwise typically appears normal. It is the most common cause of decreased vision in a single eye among children and younger adults.

The cause of amblyopia can be any condition that interferes with focusing during early childhood. This can occur from poor alignment of the eyes, an eye being irregularly shaped such that focusing is difficult, one eye being more nearsighted or farsighted than the other, or clouding of the lens of an eye. After the underlying cause is fixed, vision is not restored right away, as the mechanism also involves the brain. Amblyopia can be difficult to detect, so vision testing is recommended for all children around the ages of four to five.

Early detection improves treatment success. Glasses may be all the treatment needed for some children. If this is not sufficient, treatments which force the child to use the weaker eye are used. This is done by either using a patch or putting atropine in the stronger eye. Without treatment, amblyopia typically persists. Treatment in adulthood is not effective.

Amblyopia begins by the age of five. In adults, the disorder is estimated to affect 1–5% of the population. While treatment improves vision, it does not typically restore it to normal in the affected eye. Amblyopia was first described in the 1600s. The condition may make people ineligible to be pilots or police officers.The word amblyopia is from Greek ?μβλ?ς amblys meaning "blunt" and ?ψ ?ps meaning "sight".

Signs and symptoms

Many people with amblyopia, especially those who only have a mild form, are not aware they have the condition until tested at older ages, since the vision in their stronger eye is normal. People typically have poor stereo vision, however, since it requires both eyes. Those with amblyopia further may have, on the affected eye, poor pattern recognition, poor visual acuity, and low sensitivity to contrast and motion.

Amblyopia is characterized by several functional abnormalities in spatial vision, including reductions in visual acuity, contrast sensitivity function, and vernier acuity, as well as spatial distortion, abnormal spatial interactions, and impaired contour detection. In addition, individuals with amblyopia suffer from binocular abnormalities such as impaired stereoacuity (stereoscopic acuity) and abnormal binocular summation.[11] Also, a crowding phenomenon is present. These deficits are usually specific to the amblyopic eye. However, subclinical deficits of the "better" eye have also been demonstrated.

People with amblyopia also have problems of binocular vision such as limited stereoscopic depth perception and usually have difficulty seeing the three-dimensional images in hidden stereoscopic displays such as autostereograms. Perception of depth, however, from monocular cues such as size, perspective, and motion parallax remains normal.

ROP

RETINOPATHY OF PREMATURE BABY TREATMENT

Retinopathy of prematurity (ROP) is an eye disorder caused by abnormal blood vessel growth in the light sensitive part of the eyes (retina) of premature infants.

ROP generally affects infants born before week 31 of pregnancy and weighing 2.75 pounds (about 1,250 grams) or less at birth. In most cases, ROP resolves without treatment, causing no damage. Advanced ROP, however, can cause permanent vision problems or blindness.

In ROP, blood vessels swell and overgrow in the light-sensitive layer of nerves in the retina at the back of the eye. When the condition is advanced, the abnormal retinal vessels extend into the jellylike substance (vitreous) that fills the center of the eye. Bleeding from these vessels may scar the retina and stress its attachment to the back of the eye, causing partial or complete retinal detachment and potential blindness.

Treatments

How ROP is treated depends on its severity. Some of the treatments have side effects of their own. Newer research has shown promise in treating advanced cases of ROP with a combination of traditional therapy and drugs.

Laser therapy

The standard treatment for advanced ROP, laser therapy burns away the area around the edge of the retina, which has no normal blood vessels. This procedure typically saves sight in the main part of the visual field, but at the cost of side (peripheral) vision. Laser surgery also requires general anesthesia, which may be risky for preterm infants.

Cryotherapy

This was the first treatment for ROP. Cryotherapy uses an instrument to freeze a specific part of the eye that extends beyond the edges of the retina. It is used rarely now because outcomes from laser therapy are generally better. As with laser therapy, the treatment destroys some peripheral vision and must be done under general anesthesia.

Medications

Research on anti-vascular endothelial growth factor (anti-VEGF) drugs to treat ROP is ongoing. Anti-VEGF drugs work by blocking the overgrowth of blood vessels in the retina. The medication is injected into the eye while the infant is under a brief general anesthesia. Although no drugs have received Food and Drug Administration (FDA) approval to treat ROP specifically, some medications approved for other uses are being explored as alternatives to laser therapy, or to be used in conjunction with it.

Bevacizumab has FDA approval for treating colon cancer, but is also widely used to curb the overgrowth of retinal blood vessels in two serious adult eye diseases, wet macular degeneration and advanced diabetic retinopathy. The drug has shown some promise in treating ROP in initial research and may be an option for preterm infants at highest risk of vision loss. Other FDA-approved drugs for eye injections, such as ranibizumab (Lucentis), aflibercept (Eylea) and pegaptanib (Macugen), also are being used and studied as ROP treatments.

Combination treatment

Studies have shown that anti-VEGF drugs may improve outcomes when used in conjunction with laser therapy.

More research is needed into the timing of anti-VEGF drugs for a preterm infant, the optimal dose of the medication and how long its effects last. Doctors don't yet know the long-term impact of using these drugs in preterm infants. Some concern exists that the drugs might slow down the formation of normal blood vessels in other parts of a baby's body.