For most squints or cross-eyes, the only way to treat them is by performing a squint surgery. Yes, most squint and not all. One of the squints not treated by surgery is accommodative esotropia. Some of the more common questions we get asked when we advise a squint eye surgery are what are the risks of a squint operation and what is the squint eye surgery cost in Mumbai. More on that later.
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 6 muscles in total and we may choose to operate on one or more of them.
We will go ahead and describe a squint surgery in a little more detail. Before surgery, your squint specialist would do a detailed squint consultation. During this consultation, we would know the measurement of the squint and the type of squint. Depending on these two factors a decision would be made on which muscles to operate and by how much to move them.
The decision on how much to operate is made taking the help of certain charts or nomograms. These are charts which are 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 5mm, this is the amount the eye will move by.
On the day of surgery, the first step is to identify the muscle and then to pass sutures through the muscle. Once that is done the muscle is detached from the eyeball. In other words, the natural junction of the muscle and the eyeball is cut. The muscle is then sutured to the eyeball at a new position. This happens for each muscle that is going to be operated upon.
For squint surgeries, we use either local or general anesthesia. Local anesthesia is used for adults and general anesthesia is used for children. There is no well-defined age here. If for eg someone is 19 years old and wants a squint surgery but is too scared to get an eye injection then we would consider doing the surgery under general anesthesia. On the other hand, we have operated on 17-year-olds under local anesthesia because they were not afraid to take the eye injection of local anesthesia.
This is another common question. Can we do the surgery on a 1 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 of age. So that is a younger age limit. After that technically a squint surgery can be performed. But your squint specialist cannot jump into surgery on seeing a squint. Different types of squint are treated at different times. A squint from birth is treated early. A squint that is acquired is treated later sometimes many years after the parents first notice the squint.
Regarding operating on adults a squint surgery can be done at any age. Yes, we have operated on 50-year-olds who do not want to live with the squint anymore.
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. More often a permanent knot is used to tie 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 actually untie that knot and more the muscle and retie the knot. We are thus able to adjust the position of the muscle even after doing the squint surgery and thus this is known as adjustable squint surgery
This surgery will not benefit younger patients because they won’t be able to 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 there is one thing that can go wrong during squint surgery. Now, as mentioned earlier we move the 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 full thickness of the eyeball. In other words, it’s like poking a needle in the eye. This is known as globe perforation and is not a good complication to have. That being said there are immediate and very effective treatments that can be done that would take care of this complication. Apart from this one complication, there are a few others that are so rare and it's not worth mentioning them here.
Squint surgery is extraocular surgery. What that means is 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. The restrictions therefore and not very rigid. At eye solutions, we advise our patients to not take a head bath for the next 2 days after surgery. We also prescribe and give them certain eye drops and eye ointments which are to be used for 3-4 weeks.
The eyes turn red after the squint surgery and may remain so for upto 3-4 weeks. This is not something to be alarmed about but is something that we expect.
Usually when strabismologist the world over 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. What this means is that there is a 20% chance that a second surgery may be needed a few years down the line. Yes, a squint surgery can be repeated 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 a second and third squint surgery can be attempted without risks.
Apart from the eye drops and ointment one has to use the eyes to appear straight or almost straight after surgery. At Least that is the result we are hoping for. Most of the time the families cannot appreciate this new corrected position because the eyes are red after the squint operation. Gradually as the redness decreases members of the family start appreciating that the position of eyes 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 get rid of the double vision.
As mentioned earlier this is a very common question we get asked. The cost of squint surgery varies greatly in India. Even Mumbai for that matter. It would depend on the type of squint, the number of muscles that your squint specialist is operating upon. It would also depend on the complexity of the squint. Finally, it would depend on the expertise of your eye doctor. Squint specialists may be more expensive than eye doctors who have not specialized in treating squints.
At Eye Solutions our squint charges range from Rs 70000 to Rs 135000 depending on the above-mentioned factors.
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, eye drops are prescribed and follow-up visits advised.
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 and is done to treat amblyopia or a lazy eye.
With early detection, accurate diagnosis and proper treatment, the prognosis with strabismus treatment is excellent.