What to Expect When You’re Having Strabismus Surgery

Strabismus surgery can be nerve racking, let’s face it, but knowing what to expect can ease at least some of your nerves and help you be better prepared for your or your child’s surgery.

So what will strabismus surgery be like? You will have the procedure done on an empty stomach at an outpatient facility where you will change into a gown, walk back to the operating room, get an IV, fall asleep, then wake up sore, sensitive to light and goopy eyed. You will quickly learn that ice is amazing. The next 24-72 hours will be a blur of sleeping, icing and pain meds. Within 6-8 weeks you will be fully healed and back to normal, or at least your new normal.

If you are like me and love all the details, read on and I will walk you through each part of the process. I recently had my 4th strabismus surgery and I’m here to help you know what to expect. Read about my first, second, and third surgeries if you are interested, but I didn’t remember tons of details because I was so young.

Part 1: Before the Surgery

Before any surgery, you will definitely have a pre-surgery appointment a few days or weeks prior, where measurements are taken and the whole process will be discussed. Read about my 45 minute Q&A with the surgeon at my pre-surgery appointment here.

Outpatient surgery is generally scheduled in the morning because it must be done on an empty stomach. Priority is given to children and those with diabetes because they aren’t able to fast as easily. Being 34 and completely healthy put me last, but it was still scheduled for 9:15 am, fairly early.

Arriving at the facility will bring the fun of paperwork. Signing away your life and giving them all of your money. Because this is a planned surgery, payment, or partial payment can be expected prior to surgery, it was for me.

Next, prepare for some downtime in the waiting room. This is the perfect opportunity to take some “before” pictures so that progress can be tracked!

Once the nurse calls, get excited because there is a light blue gown waiting to be put to good use. Why is a gown necessary for eye surgery? Good question. I learned the answer when I was lying on the surgical table and they started attaching monitors to my shoulders and chest, but I’ve gotten ahead of myself.

After you dress in your excellent outfit (they will let you keep bottom underwear on), the nurse, surgeon and anesthesiologist will each take a turn to come in to talk to you.

The nurse focuses on health history and makes sure that you haven’t had anything to eat or drink since midnight the day before. If you do happen to eat by accident, your surgery will be canceled. With drinking, there is a little more wiggle room depending on what you had and how long it has been.

The Surgeon talks about what he’ll be doing and gives an opportunity for any questions you may have. Ask away. I had already asked him about a million at my pre-surgery appointment so this part was relatively short for me.

The anesthesiologist asks background questions about how anesthesia has been for you in the past and asks more background questions.

It all happened pretty quickly without much fanfare. I said goodbye to my hubby and walked down the hall and laid down in the freezing cold operating room.

Part 2: During the Surgery

I was lucky enough to be at an amazing facility with a staff that I loved for the 3 minutes that I was awake. After I was laying on the table, the nurse piled warmed blankets on me and the doctors kept up nice cheerful chatting to keep me distracted.

If you are lucky enough to have the anesthesiologist put in your IV, you probably won’t even feel it. I have a tendency to pass out when IVs take several tries so I always get super nervous about this part, but it was no big deal. I literally didn’t feel it and I was so relieved!

I kept asking them when I was going to fall asleep. The last thing I remember is someone saying, “This should help you relax.” and then I was out.

The length of strabismus surgery varies from person to person depending on what the surgeon is doing. My surgeon operated on both sides of both eyes so my surgery was on the longer end at 85 minutes, but it can be as quick as 45 minutes.

The surgeon cuts into the clear lining of your eyeball, folds it out of the way to access the muscle, then does a little cutting and pasting, and sews you right back up. It seems simple, but there is an art to the whole process that takes an extremely specialized doctor.

Part 3: Waking Up

The first thing I remember post-surgery is someone trying to help me put my clothes back on, that ought to wake anyone up, right?

My brain must have panicked just enough to bring me out of my slumber and I confidently told the nurse I could do it myself. I was wrong. I totally needed help and succumbed and let her help me.

I was able to barely open my eyes enough to see my clothes and put them on, but the light felt so incredibly bright so I just closed them back up, and fell asleep immediately.

My first moments of opening my eyes after surgery

I must have complained about pain, because the next thing I remember is someone putting pills in my mouth and giving me water to drink, all while my eyes were closed.

My husband came in and they must have removed the ice pack from my eyes because I opened my eyes and he was right in front of me exclaiming, “she’s opening her eyes!!!” It made me laugh, I wonder if that’s what newborns feel like when they open their eyes for the first time.

In the moment, I felt totally coherent the whole way to the car and on the 3 hour drive home, but looking back, I realize that I must have been in and out of it the entire time. I’ve looked back on videos he took and there are plenty of conversations that I don’t remember.

The Recovery

I quickly found that while pain meds helped some, ice was what made the biggest difference. With ice on my sore eyes, I would feel no pain. As soon as I removed the ice pack, they would burn. I kept fresh ice on my eyes for about 75% of the time for the first 2-3 days. When I wasn’t icing, I was rinsing out the goop with a clean warm washcloth or taking my meds. It was all a blur for a few days.

The recovery is said to become more difficult with each surgery, so children seem to have a much quicker recovery than adults. Some adults feel physically ready to go after a day or two, but that wasn’t the case with me.

Sitting with my eyes closed, the pain was gone in 2 days. If my eyes were open and moving, the pain and soreness lasted for about 8-10 days, getting better every day. Even still, 3 weeks later, I feel some muscle strain when I try to look far to the sides. It is 100% manageable, I wouldn’t even consider taking pain meds, but there is still soreness (and redness) that is said to take 6-8 weeks to fully go away.

Here are the day by day pictures for the first week post-surgery. The coloring went from dark red, to light red, to yellow, to pink. After the first week, my surgeon adjusted my sutures so my right eye had to start the healing process all over again.

A huge piece of the recovery depends on how well the eyes were aligned. My initial surgery left my eyes very un-aligned. There was a difference of 60 degrees from before to after! That first week was awful as far as visual confusion, dizziness and double vision were concerned. After he adjusted my sutures and my eyes were more straight, it was WAY better!

If you are part of the rare group whose eyes immediately work together following surgery, the recovery will be pretty simple. Ice, pain meds, extra sleep and you will be set. This is more rare though, so try not to set your heart on this option, if it does happen, you can be happily surprised.

There is another group of strabismics that have suppressed one eye their whole life so the surgery is more to help the eyes appear straight and help with peripheral vision. This group tends to experience a day to a week or two of double vision or visual confusion while the brain sorts things out and then goes back to suppressing. This obviously changes for every person which is so irritating. So many unknowns! But in general, if you suppressed before, you will continue to suppress fairly quickly after.

I don’t know where I fit in here. I suppressed my right eye until I turned 32 and started doing vision therapy. I was able to wake up my other eye and learn to use both together. This took a conscious effort to bring my eyes together and I wasn’t able to keep them straight for very long so I opted for surgery.

When the surgery overcorrected my eye turn, it really threw my brain for a loop. I am a few weeks out and my brain is still trying to sort things out.

The first week I felt very dizzy and nauseous anytime I was moving. Holding still wasn’t so bad. When I tried walking heel to toe with one eye covered, I would fall over, there was no balance there. Those symptoms lessened over time and after my sutures were adjusted. The more I moved, the more quickly my brain adjusted.

I tried riding a bike about 10 days out from surgery and completely rear-ended my husband and daughter and bent my bike basket so there were definitely some depth perception and peripheral vision problems.

My problem is that I have worked so hard to use both eyes together by forcing my right eye in. When I try to use those techniques now, it just crosses my eye more, making my vision even worse.

I’m a few weeks out now and I’m learning that I just can’t try to force it, I have to relax and just allow my brain to sort things out. It’s not horrible, but it is much more complicated than I had anticipated.

After about 2 weeks I finally started driving, but it is still scary for me because I will suddenly get double vision. I just keep a patch in the car and patch my right eye, if needed. If I focus on my peripheral vision, I can quickly make the double vision go away.

The Mental Battle

The first week was very hard, mentally. Why?

My alignment was not good and I was terrified that the surgery had failed.
I was lonely after spending 2 days in a dark room with ice over my eyes.
I could barely walk in a straight line and felt very disoriented.
The double vision was confusing and frustrating.
My brain was exhausted from trying to relearn how to see and I had to sleep a TON!

I was not prepared AT ALL for the mental aspect of recovery so that made it challenging. I had super high expectations and they were not at all met so I felt very disappointed at first. It all worked out eventually, but those first few days and weeks were tough, mentally.

I highly recommend preparing yourself for any outcome. If things work out magically for you, hooray, but if things are hard, you will be ready for them.

Don’t assume that you will have a 2 day recovery and be back to work. That is extremely rare, for most people it takes at least 1-2 weeks to be feeling normal again. It will all work out, but prepare to have your patience tested!

Was it Worth It?

The big question for most people considering strabismus surgery is, did it work??? Was it worth the red, swollen, goopy eyes? Was it worth the double vision and dizziness?

I’m going to go with numbers on this one. In the United States, 70% of strabismus surgeries are considered a success. “Success” includes everything from perfectly straight eyes, to a turn of 10 degrees or less. So for every 10 people who get strabismus surgery, 7 get good results, and 3 do not.

My eye turn went from 35 degrees of exotropia to 25 degrees of esotropia. My surgeon used adjustable sutures and was able to adjust the turn to be only 6 degrees of esotropia which is supposed to go away over the next 6-8 weeks. I will update with a picture when we have the final results.

As far as my surgeon is concerned, my surgery was a huge success, because my turn is now 6 degrees instead of 35. According to me, the verdict is still out.

I am going for stereopsis, which means both eyes need to work together. I was hoping it would come automatically, but it looks like it is going to take quite a bit more work in Vision Therapy. I have a feeling that it is all going to work out in the end, it’s just going to take some time to learn how to use these new eyes! I’ve put my brain through quite a bit in the last month!

Before Surgery (35 D out), After Surgery (25 D in) and After Suture Adjustments (6 d in).

If you have any questions that I didn’t answer in this post, just put them in the comments and I will do my best to answer them! Good luck with your strabismus surgery!