For most squints or cross-eyes, the only way to treat them is by performing squint surgery. Yes, most squints and not all. One of the squints not treated by surgery is accommodative esotropia. Some of the more common questions we are asked when we advise an eye surgery squints are the risks of a squint operation and the cost of squint eye surgery in Mumbai. You will find a more detailed note on the cost of squint eye surgery here.
We, as squint specialists or strabismologist, move the muscles of the eyes. The muscles are known as extraocular muscles. These muscles are responsible for moving our eyes up down left and right. There are six muscles in total, and we may choose to operate on one or more of them.
Measuring the squint
Before surgery, your squint specialist would do a detailed squint examination. During this consultation, we would know the measurement of the squint and the type of squint. Your squint surgeon would then decide on which muscles to operate on and by how much to move them.
Deciding how much to operate
We decide on how much to operate by taking the help of specific charts or nomograms. These are charts made and, of course, changed many times over the past many years by experiences of a large number of squint surgeries. In other words, these tell us if one muscle is moved by, let's say, five mm, this is the eye position will change by x degrees.
Moving the eye muscles
On the day of surgery, the first step is to identify the muscles and pass sutures through the muscles. We then detach the muscle from the eyeball, meaning the natural junction of the muscle and the eyeball no longer exists. We then suture the muscle at its new position on the eyeball. This step happens for each muscle that we operate upon.
For squint surgeries, we use either
There is no well-defined age here. If e.g., someone is 19 years old and wants a squint eye surgery in Mumbai but is too scared to get an eye injection, we would consider doing the surgery under general anaesthesia. On the other hand, we have operated on 17-year-olds under local anaesthesia because they were not afraid to take the eye injection of local anaesthesia.
What is the best age for squint surgery is another common question. Can we do the surgery on a one or 2-year-old child? Or is there an age limit for squint surgery? In general squint, surgeries are not done before 10-12 months. So that is a younger age limit. After that, technically, a squint surgery can be performed at any age. But your squint specialist cannot jump into surgery on seeing a squint. Different types of squints are treated at different times. A squint from birth is treated early. An acquired squint is treated later, sometimes many years after the parents first notice the squint.
For example, in Exotropia, the squint is not present all the time. It is intermittent. We operate on this squint only when the squint is present for more than 50% of the waking hours. The squint being present for 50% of the time may occur a year after the squint is first noticed or take more than ten years.
Your squint surgeon can do squint surgery in Mumbai at any age as regards adults. Yes, we have operated on 50-year-olds who no longer want to live with their squint.
We mentioned earlier that we take the muscle from its original position and suture it in its new position. We do this by using sutures or tying material. We all know how to tie knots. One can tie permanent knots or tie knots like we do when we tie our shoelaces. A permanent knot is often used to connect the muscles to their new position. In an adjustable squint surgery, a shoelace knot is used. Once this temporary knot is tied, we see the patient again the next day, and if we feel we have to adjust the position of the muscle, we untie that knot and more the muscle and retie the knot. We can thus change the muscle's position even after doing the squint eye surgery in Mumbai, and therefore this is known as adjustable squint surgery.
This surgery will not benefit younger patients because they won’t cooperate with us during the adjustment part of the squint eye treatment the next day.
Mostly a squint operation is quite a safe procedure. That being said, one thing can go wrong during squint surgery.
Eyeball perforation - Eyeball gets punctured with needle
As mentioned earlier, we move a muscle to a new position. We do that by suturing the muscle to its new position. This suturing is done by a needle that is attached to the thread. We have to pass the suture through the wall of the eye, making sure that we are within the thickness of the wall. This wall is also known as the sclera and is the white part of the eye. It is possible that when your squint surgeon is taking this suture, his needle may go the entire thickness of the eyeball. In other words, it’s like poking a needle in the eye. Going through the whole thickness of the eyeball is known as globe perforation and is not a good complication. That being said, immediate and very effective treatments can be done that would take care of this complication. Apart from this one complication, a few others are rare, and it's not worth mentioning them here. Very very rarely, this globe perforation can lead to a retinal detachment.
Squint surgery is extraocular surgery. That means that we don’t go into the eyeball during this surgery. The walls of the eyeball remain intact. Because of that, the risks of eye infections post this surgery are almost nil. Thus the restrictions and not very rigid. These restrictions are not like the precautions needed after cataract surgery.
After the squint surgery, the eyes turn red and may remain so for 3-4 weeks. We expect this, and thus there is nothing to be alarmed about.
Usually, when strabismologists worldwide operate, they give a success rate of about 80%. For some squint treatments, the rate may be higher, and for a fewer number, the rate may be lower. This success means a 20% chance that you may need a second surgery a few years down the line. Yes, your squint specialist can repeat a squint surgery without any risks. There actually are certain risks, but all squint surgeons are aware of these risks and thus take steps to avoid them. So yes, your squint specialist can attempt a second and third squint surgery without risks.
Apart from the eye drops and ointment, one has to use the eyes to appear straight or almost straight after surgery. Most of the time, the families cannot appreciate this corrected position because the eyes are red after the squint operation. Gradually as the redness decreases, family members start enjoying that the eye's position has changed.
There is a possibility that the patient may see double after the squint surgery. Most of the time, this settles down as the eyes and vision adjust to the new position. Sometimes this does not go away, and your eye specialist may have to prescribe you glasses to eliminate the double vision.
Another common question we get asked is will the glasses go away after squint surgery. You must know that the glasses will not go away, and if you have an eye power, then that eye power can only go away after performing a Lasik eye surgery.
As mentioned earlier, this is a common question we get asked. The cost of squint surgery varies significantly in India. Even Mumbai, for that matter. It would depend on the type of squint and the number of muscles your squint specialist operates on. It would also depend on the complexity of the squint. Finally, it would rely on the expertise of your eye doctor. Squint specialists may be more expensive than eye doctors who do not treat squints.
At Eye Solutions, our squint charges range from Rs 70000 to Rs 135000, depending on the aforementioned factors. Read a detailed post on the cost of squint surgery.
The eye is bandaged for a few hours on the day of surgery. The best squint specialists in Mumbai sometimes do what is known as ‘adjustable squint surgeries’. Here the eye may be patched for a day. Read more about this in squint surgery.
After surgery, prescribe eye drops and advise follow-up visits.
The treatment does not stop with surgery. Glasses may have to be continued to maintain clarity of vision. Patching therapy may be needed to be continued for some time after the surgery to treat amblyopia or a lazy eye.
With early detection, accurate diagnosis, and proper treatment, the prognosis with strabismus treatment is excellent.