Surgery

Surgery to correct a squint may be recommended if other treatments are not suitable or do not help.

The operation involves moving the muscles that control eye movement so that the eyes line up better.

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 will not 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 will not 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 eyedrops 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 eyedrops to help with healing.

You may experience some of the following side effects:

• eye pain – this tends to last 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 should not be given aspirin
• blood in your tears and watering eyes – this can last for a few weeks
• 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 visits with an eye specialist after surgery. Contact them, the hospital or a 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
• do not 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 be advised to avoid swimming for 4 weeks and contact sports (such as rugby) for 6 weeks
• do not use make-up close to the eyes for 4 weeks
• your child should not play in sand or use face paint for 2 weeks

If you wore glasses before surgery, you'll probably still need to wear them. But do not 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.

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

Speak to the surgeon about the risks of surgery before the operation.