Esotropia surgery

Children are the people that a family pays the most attention to and cares about. The physical health of children is also what their parents are most concerned about. Whether it is a headache or a fever or a fall and a sore foot, it is enough to make the family nervous for a while. Eyes are the windows through which people see the world and the bridge through which they communicate with the world. Most of the ways that babies learn about the world are through their eyes. When parents find that their children have strabismus, they should consider performing strabismus surgery in a timely manner.

For asymptomatic latent strabismus, no treatment is required because children have strong fusion and convergence abilities. However, some children with latent strabismus experience symptoms of visual fatigue such as eye swelling, orbital pain, and headache after close work, and appropriate treatment can be given.

Surgical method

Different treatment methods are used depending on the severity of strabismus:

For esotropia, the pupil needs to be dilated and the eyes need to be refraction tested. Those with hyperopia should be fitted with appropriate glasses. For exotropia, convergence training can be performed to strengthen the adductor muscles of both eyes to overcome the exotropia. If the effect is not good, prism glasses can be worn. For exotropia greater than 10° (20Δ) when looking at near objects, surgical treatment can be considered.

Intermittent esotropia is mostly hyperopia. Once it is discovered, the pupil should be dilated and refraction should be performed to correct it with adequate hyperopia glasses. After wearing the glasses, the intermittent esotropia can usually be completely corrected. Children with intermittent exotropia should undergo strabismus and synoptophore examinations to understand their binocular vision function, and receive surgical treatment as soon as possible before binocular vision function is lost. If binocular vision is lost, it is still possible to restore it to normal through surgical correction before the age of 7. If the degree of strabismus is very small, you can wear negative glasses and do convergence training, but it can only alleviate the symptoms and is not easy to cure.

For manifest strabismus, except for accommodative esotropia, early surgical treatment is often required.

Different methods are used according to different causes of strabismus:

Although congenital esotropia in concomitant strabismus has nothing to do with eye adjustment, it has a great impact on the development of binocular vision function. The best treatment is surgical correction at the early stage of visual function development at the age of 2. Esotropia that occurs after the age of 2 to 3 is mostly related to excessive accommodative convergence caused by hyperopia. This type of strabismus requires full mydriasis and eye examination. Those with hyperopia should be fitted with adequate glasses and wear them for 3 to 6 months to correct or partially correct the strabismus, and then surgical treatment can be performed for any remaining esotropia. If the esotropia does not change after wearing glasses, the only treatment is surgery. If the strabismus is completely corrected, you can continue to wear glasses. If the hyperopia is very high, you can also correct the strabismus through surgery and reduce the degree of glasses you need to wear.

For patients with manifest exotropia, the principle of treatment is early surgery after excluding obvious refractive errors. If the eyesight is poor, the pupil needs to be fully dilated and the eyes need to be refractionated. If the exotropia is caused by frequent lack of adjustment, appropriate myopia glasses should be worn and the exotropia may be corrected. If hyperopia is combined with amblyopia, glasses with a lower degree should be fitted to correct the best vision, and amblyopia training should be performed. If exotropia still exists, surgical treatment is required.

Risks of surgery

There are many eye diseases, and strabismus in children is one of them. Strabismus in children should not be ignored. It has a great impact on children's facial features. So how big are the risks of pediatric strabismus surgery? In fact, any surgery has risks. Just try to avoid risks when doing surgery. The risks of this surgery are not very high.

Strabismus surgery is a type of eye muscle surgery. The surgical site is not on the eyeball and has no effect on vision and other functions. There is basically no risk if you go to a regular professional hospital to have it done.

Strabismus surgery is a common ophthalmological operation. Strabismus cannot be cured on its own and can only be corrected through surgery. As for the risks of strabismus surgery in children, experts further pointed out that any surgery has risks, but for strabismus surgery in children, the risks are relatively much lower. And the success rate is quite high.

Timing of surgery

For congenital esotropia discovered within 6 months of birth, surgery should be performed at 1 to 2 years old, before binocular single vision function develops. If esotropia occurs after 6 months, you must not undergo surgery immediately. You must first dilate your pupil and have your eyes tested. If you have hyperopia, wear adequate corrective glasses for 3 to 6 months. If the esotropia is completely corrected, no surgery is necessary and the condition can be cured by continuing to wear glasses. If you wear glasses for more than 6 months and the esotropia is only alleviated, the remaining strabismus should be operated on as soon as possible. If there is no change in strabismus after wearing glasses, surgery should be performed earlier.

Monocular constant esotropia can be treated with patch therapy first to induce alternating strabismus, and then surgery can be performed. This is beneficial for restoring binocular single vision function. If covering for more than half a year is still ineffective, surgical treatment can also be used.

Exotropia should be treated with surgery as early as possible, especially intermittent exotropia. Although it can be treated with conservative therapy, it can often only reduce the degree of strabismus and most cases cannot achieve the goal of cure. The disease is treated with surgery as the first choice, and surgical correction should be performed as early as possible before obvious exotropia forms and binocular single vision function is completely lost. The best time for surgery is between 4 and 6 years old.

In principle, for strabismus combined with amblyopia, amblyopia should be treated first and then strabismus. The surgical effect can be consolidated only when vision is improved. But for large-degree strabismus, the strabismus must be corrected first, otherwise the strabismic eye cannot focus well and the amblyopic eye cannot be treated well.

For esotropia or exotropia caused by intraocular diseases and whose vision cannot be restored, surgery should be performed after the age of 12.

Postoperative Care

1. Postoperative care for strabismus surgery is not difficult. Children should pay more attention to rest, close their eyes and relax, and eat less or no spicy food.

2. The use of antibiotics after strabismus surgery and precautions when changing dressings. Systemic antibiotics should be used after surgery to prevent postoperative infection. Dressings should be changed on the operated eye starting the next day. When changing dressings, pay attention to whether the wound is growing well and whether there is bleeding or cracking. The dressing bandage should not be applied too tightly to avoid the oculocardiac reflex.

3. Prevent and treat conjunctival edema. Conjunctival exudation and edema are the main postoperative reactions of hydroxyapatite orbital implantation. The main reason is the stimulation of the conjunctiva during surgery, which causes bleeding due to poor postoperative bandaging, affecting blood circulation and slow wound healing. Therefore, postoperative wet compress method is adopted. On the third day after surgery, soak a sterile eye pad with 30% magnesium sulfate solution and apply it to the affected eye.

4. Both eyes will be bandaged after strabismus surgery. The patient should be advised to close his eyes and rest, and move his eyeballs as little as possible to avoid affecting healing. Use a sterile saline cotton swab to clean the eye secretions and scabs every day, then use 0.25% chloramphenicol eye drops to apply to the incision and conjunctival sac. Apply 0.5% chloramphenicol eye ointment and finally fix with a bandage. The bandage can be opened 1 to 2 days after the stitches are removed.

Precautions

The refractive status of children should be checked before strabismus surgery. If there is refractive error, they should wear appropriate glasses. If strabismus still exists after wearing glasses, surgical treatment is required. Check binocular vision. If the child has amblyopia, the amblyopia should be treated first, followed by strabismus surgery. For children with strabismus, in order to achieve functional cure, visual function training can be performed before surgery if conditions permit, so as to achieve a certain range of fusion and stereoscopic vision function.

In order to perform strabismus surgery properly and avoid unexpected accidents, after the scheduled surgery, both eyes need to be treated with antibiotic eye drops until the day of surgery. A full body examination should also be performed before surgery, such as blood and urine routine tests, blood sugar, electrocardiogram, vital signs, etc. If the child is relatively young, the operation needs to be performed under general anesthesia. The child should be on an empty stomach and not eat or drink anything on the day of the operation to prevent vomitus from entering the trachea during the operation and causing suffocation. Female patients should avoid surgery during their menstrual period.

Children who undergo local anesthesia surgery for strabismus may experience nausea and vomiting after the operation due to eating breakfast or lunch, which may cause muscle stretching during the operation. The way to prevent it is to eat less light food and avoid greasy food before surgery.