Squint - Having surgery for a squint

If other treatments are unsuccessful, surgery may be needed to correct a squint.

Surgery can be used to:

• improve the alignment of the eyes (and therefore their appearance)
• help the eyes work together

The operation

Surgery involves moving the muscles attached to the outside of the eye to a new position. It may be necessary to operate on both eyes to balance them, even if the squint is only in one eye.

The operation is carried out under general anaesthetic and usually takes less than an hour to perform. It is often carried out as a day case, so your child can go home the same day.

You may be able to accompany your child to the operating theatre and stay with them until they have been given the anaesthetic. A nurse will be with your child throughout the procedure.

During the operation, your child's eye will be kept open using an instrument called a lid speculum. The ophthalmologist (eye care specialist) will detach one part of the muscle connected to your child's eye and will either move it backwards to weaken the pulling effect, or shorten it to increase the pulling effect. Once the correction has been made, the muscles will be sewn back into place using dissolvable stitches.

Risks of surgery

As with any kind of operation, there is a risk that problems will arise due to surgery to fix a squint.

If you or your child are having surgery for a squint, ask your ophthalmologist (eye care specialist) to discuss possible risks with you before the operation.

Risks of eye surgery include:

• The possibility of further surgery, which is sometimes needed if the squint is severe. 
• The eye may remain red for a long time after the operation. This is rare, but it may be caused by scar tissue forming on the surface of the eye.
• Double vision may occur after the operation. This usually resolves after a week or so.
• The squint may recur and another operation may be needed.
• One of the eye muscles may slip after the operation, although this is very rare. This makes the eye point inwards or outwards (depending on which muscle has slipped) and can impair eye movement. It may need to be operated on again.
• In rare cases, the inside of the eye can be damaged during surgery.
• An infection may develop after the operation. This is possible with any type of surgery. In the case of eye surgery, eye drops or ointment can be used to reduce the risk.

One study that looked at squint surgery for adults estimated that around one in five people may need more than one operation to treat their squint successfully. Double vision occurred in less than 1 in 100 cases. This usually either improves with time, or it can be treated with further surgery, for example. 

In children, it is more common to need another operation to correct the squint, particularly if the first operation was carried out when the child was very young. Some studies have found that around 6 out of 10 children who have squint surgery at about one year of age need to have another operation at some point.

Other complications in children are usually rare, but you should ask your ophthalmologist for more information.

Recovering from surgery

It can take several weeks to fully recover from corrective eye surgery. After surgery, you or your child may have a sore eye for a few days. The pain can be treated using simple painkillers, such as paracetamol. Children under 16 years of age should not be given aspirin. If the pain does not improve, speak to your eye care specialist or visit your GP.

Following eye surgery, a pad may be put over the affected eye, which will usually be removed before you or your child are discharged from hospital. There is no need to wear a patch or bandage at home and you can return to daily activities, such as reading, as soon as you  feel able to. The aim is to get the eyes working normally as quickly as possible.

Going home

Your care team will be able to give you more specific advice about returning home after an eye operation, but some general tips include:

• you or your child may not feel like eating, but you should drink water at regular intervals
• the stitches can take up to six weeks to dissolve and it may feel like there is a bit of grit in the eye or the eye may be itchy – try not to rub it
• avoid washing your hair for a few days and try not to get any soap or shampoo in the eye
• your child should not play in sand or use face paint for two weeks after the operation
• you or your child will need to go back to your eye care specialist for regular follow-up visits
• if you or your child wore glasses before the operation, it is likely that you will still need to wear them after the procedure

Returning to school or work

Your child should be able to return to school or nursery about a week after surgery. If you have had surgery, you should also be able to return to work after about a week.

Sports

After surgery, you or your child should avoid playing sports for around two weeks. You may need to avoid contact sports, such as rugby, for up to a month. Swimming should be avoided for at least a month after the operation.

Driving

If you have had surgery to correct a squint and you drive, you should ask your surgeon when you can drive again. You should not drive if you have double vision.