It’s never too early for an ophthalmological examination since the development of vision is most intense in very young children, and possible disorders of eye position and refractive errors can be most effectively corrected at this time. Until the age of 6 months, it is normal for the eyes to slightly deviate due to the immaturity of the nervous system, but if the eye deviates after this age, it is most likely some form of strabismus. It is true that very young children cannot cooperate, so their actual visual acuity cannot be determined, but with special devices that are adapted to their age, which we have in our institution, as well as by dilating the pupils and using skiascopy, it can be determined if they have a refractive error (plus or minus diopter). If necessary, glasses can also be prescribed.
One of the methods of treating strabismus is through surgery, but before deciding on an operative procedure, a detailed examination with pupil dilation is needed to determine the angle of eye deviation with and without correction, the actual diopter, and whether the child has low vision. If a diopter difference is found between the correction the child wears and the wide pupil, it is first necessary to strengthen the glasses, cover the eye that sees better, then do a follow-up after a few months. If the strabismus angle is corrected by glasses, then we talk about accommodative strabismus. In that case, surgery is not necessary, because only the angle of eye deviation that is not corrected by glasses is corrected surgically. If after several months the angle remains the same or is not corrected enough, it is necessary to plan an operative procedure.
After strabismus surgery, it is possible for the eye to deviate again to the same or even the opposite side, which is more common if the operated eye has low vision. A reoperation of an already operated strabismus is possible and, depending on the angle of eye deviation, can be done on one or both eyes. The principle of surgical treatment of strabismus involves shortening or changing the grip of the external eye muscles that move the eye, thereby changing the eye position. The type of surgery applied, how many muscles are involved, and whether it is on one or both eyes, depends on the intraoperative findings on the muscles that have already been operated on.
For many patients, strabismus represents a significant aesthetic and social problem, so patients are highly motivated for surgery for this reason. In patients whose deviating eye has severe low vision, a surgical procedure can also be performed, which is more of an aesthetic nature, but with limited expected results after surgery, as that eye cannot fixate and thereby provide a stimulus to stay in a straight position. The chance that this eye will deviate again to the same or the opposite side is much higher than when the eye has good visual acuity, and it is sometimes necessary to repeat the surgery.
Strabismus surgeries are typically performed under general anesthesia and this is the only reason why the patient needs to stay overnight in the medical institution until the next morning. Otherwise, recovery is quick, after the operation the eye is slightly swollen and red because an incision is made in the conjunctiva to reach the muscles that move the eye. By the second day after the surgery, the eye can remain open. It is important to regularly use the prescribed therapy after the surgery and to avoid physical exertion for at least a month. The swelling subsides within a few days, and the redness completely disappears within a few weeks.
The surgical procedure on the eye muscles itself does not affect the diopter, so if the patient wore glasses before, they must continue to wear glasses after the operation. In some cases, glasses correction partially or even completely corrects the angle of eye deviation, and the type of surgery to be performed depends on this. Therefore, it is important that patients undergoing strabismus surgery, who have different angles of eye deviation with and without correction, continue to wear glasses after surgery as the operation will correct the eye deviation only as much as the eye deviates when the patient wears correction.
In cases like yours, when the nerve that innervates the lateral eye muscle (abducens nerve) is damaged, the eye on which the damage occurred cannot cross the midline or it crosses but does not go to the end in abduction (outward gaze), often leading to double vision. People with such damage have to move their heads so that both eyes look to the side of the paretic muscle, thereby reducing double vision. This condition cannot be cured, but depending on the severity of the damage, it can be alleviated either by wearing glasses with prisms or by surgery. The operation can achieve a straight gaze on the side of the paretic muscle, which somewhat helps in reducing symptoms, and also satisfies patients in an esthetic sense.
