Diagnosis and Treatment of Strabismus

Diagnosis of strabismus is a procedure in our clinic that includes the following examinations:

• visual acuity assessment and selection of optical correction
• refractive error examination after cycloplegia
• assessment of potential fundus pathologies
• detection and treatment of amblyopia
• assessment of the squint angle
• assessment of near and distance stereoscopic vision
• eligibility for surgical treatment.

Strabismus is a condition that affects both children and adults.

In children, the presence of strabismus is pathological when it persists after six months of age. Therefore, an ophthalmological examination should not be delayed in young patients. Strabismus present from childhood can significantly disrupt the development of the visual system and lead to severe visual impairment. Treatment should therefore begin as early as possible. Surgical procedures for strabismus in children can be safely performed as early as the end of the second year of life.

In adults, strabismus treatment is more often cosmetic, which does not mean it should be abandoned. Achieving a significant visual improvement in eye alignment significantly improves patients’ well-being and gives them confidence in daily life. However, it should be remembered that a good result obtained after surgical treatment may not be permanent. Occasionally, binocular vision can be achieved in adults after strabismus surgery.

Paralytic strabismus constitutes a separate group, which most often causes double vision. This type of strabismus can also be surgically treated, but it should be noted that normal eye movement is usually not achieved. The main goal of procedures in this group is to eliminate double vision.

Dobry Wzrok Ophthalmology Center has a modern ophthalmology department with an operating room, located in the same building as the ophthalmology clinic. All procedures are performed under general anesthesia, with anesthetic care. Procedures are performed on a day-case basis: the patient can be discharged home on the same day in the afternoon after an anesthetic check-up.

Surgical Scope

Surgical treatment of strabismus in adults and children is performed in the following cases:

• previously untreated strabismus
• unsatisfactory cosmetic or functional result after previous surgical treatment (reoperations)
• consecutive strabismus, i.e., strabismus that changed its angle of deviation after previous surgical procedures (reoperations)
• paralytic strabismus – in the course of neurological or internal diseases

Surgical Methods

In predictable cases, for patients who have not undergone previous surgical treatment, we use classic surgical methods involving the shortening and repositioning of eye muscles.

In cases of paralytic strabismus, we perform muscle transposition procedures: difficult procedures, but giving the patient a chance to eliminate double vision.

In patients who have previously undergone surgical treatment, and in individuals where it is difficult to predict the effects using classic surgical methods, we perform procedures using adjustable sutures. In this procedure, the main part of the operation is performed under general anesthesia, but some of the sutures are not yet permanently tied. On the same day, a few hours after the general anesthesia wears off, we perform the adjustment and tying of the sutures. This procedure is performed under local anesthesia, with the active participation of the patient. Performing such an adjustment offers greater possibilities for achieving a good cosmetic result.

Notes for patients undergoing surgical treatment for strabismus

• a good cosmetic result after surgical treatment for strabismus can be achieved at any age
• surgical treatment should not be abandoned in adult patients with neurological and internal diseases (paralytic strabismus)
• surgical treatment for strabismus has no effect on refractive error and the optical correction used
• if the patient wants to undergo both laser refractive surgery and strabismus correction, they should first undergo the laser procedure and only after several months undergo strabismus surgery
• a functional effect in the form of binocular vision after surgical treatment in adulthood is very rarely achieved
• a satisfactory cosmetic result obtained after surgical treatment may not be permanent, and the possibility of strabismus recurring should be considered despite a correctly performed procedure
• there are situations, independent of the surgical technique used, when another surgical procedure is necessary to achieve the desired therapeutic effect