adjustable suture surgery in strabismus

Understanding Adjustable Suture Surgery in Strabismus

Strabismus, commonly known as “crossed eyes” or “lazy eye,” is a condition in which the eyes do not align properly, leading to misalignment and potential vision issues. Strabismus can significantly impact depth perception and visual acuity, especially in children. Traditional strabismus surgery has been a standard treatment option; however, adjustable suture surgery has emerged as a refined and sophisticated alternative. This blog explores adjustable suture surgery, including its benefits, procedure, post-operative care, and potential risks.

adjustable suture surgery in strabismus

What is Adjustable Suture Surgery?

Adjustable suture surgery is a specialised technique used to treat strabismus with high precision and flexibility. It allows the surgeon to make minor adjustments to the positioning of the eye muscles after the initial surgery. This technique is particularly beneficial for complex cases where achieving perfect alignment is challenging.

  • Definition and Explanation: During the surgery, the ophthalmologist initially positions the eye muscles using standard sutures. After the surgery, while the patient is awake, the surgeon can adjust the sutures to fine-tune the positioning for optimal eye alignment.
  • Benefits: Adjustable suture surgery offers several advantages over traditional surgery, including the ability to correct minor deviations in eye alignment and reduce the risk of under-correction or over-correction. This approach often results in a higher success rate and a more precise outcome.

When is Adjustable Suture Surgery recommended?

Adjustable suture surgery is often recommended in specific cases where traditional surgery might not provide the desired outcome or where complex strabismus needs more precise alignment.

  • Complex strabismus: In cases where multiple muscles are involved or where the strabismus is more complex, adjustable sutures offer greater control and flexibility during postoperative adjustments.
  • Inconsistent eye movements: For individuals with inconsistent eye movements due to factors like neurological conditions or trauma, adjustable sutures can offer real-time adjustments.
  • Previous surgery complications: If there have been issues with previous strabismus surgeries, adjustable sutures provide an opportunity to make fine adjustments for optimal alignment.

Adjustable Suture Surgery Procedure 

Adjustable suture surgery is a precise and sophisticated approach to strabismus treatment, designed to optimise eye alignment. The procedure involves several stages:

1. Anaesthesia:

  • Local anaesthesia is typically administered to numb the surgical area. This ensures that the patient remains comfortable throughout the procedure. Occasionally, mild sedation may be provided to help the patient feel more relaxed during the surgery.

2. Initial muscle repositioning:

  • The surgeon makes small incisions around the eye area to access the muscles responsible for eye movement. The eye muscles are repositioned to correct the misalignment. Traditional sutures are used to anchor the muscles in the desired position. This phase of the surgery is similar to traditional strabismus surgery and serves to initiate the correction of eye positioning.

3. Post-operative adjustment:

  • Once the patient regains full consciousness and the anaesthesia has worn off, the ophthalmologist performs a detailed evaluation of the eye movements. During this time, the surgeon can make minor adjustments to the positioning of the sutures while observing the eye movements to ensure precise alignment. The adjustments are made to fine-tune the positioning of the eye muscles, optimising the final eye alignment. The surgeon may also use specific diagnostic tools to measure eye movements and assess the alignment more accurately.

4. Final fixation:

  • After the ophthalmologist is satisfied with the eye alignment, the sutures are securely tied and finalised. These adjustments ensure that the final positioning of the eye muscles will provide the optimal outcome. The sutures are typically reinforced to prevent any movement during the recovery phase.

5. Post-operative monitoring and care:

  • After the surgery, patients will require monitoring to manage any postoperative discomfort, inflammation, or infection. Cold compresses and prescribed medications can help alleviate discomfort and inflammation. It is essential to maintain regular follow-up visits to monitor the surgical outcome.

This approach provides the ophthalmologist with a refined tool to ensure optimal eye alignment, contributing to better outcomes and overall patient satisfaction.

Advantages of Adjustable Suture Surgery

  • Precision in achieving alignment: Provides the ophthalmologist with the ability to fine-tune the positioning of the eye muscles during the postoperative phase, ensuring optimal alignment.
  • Improved surgical outcomes: The precision offered by adjustable sutures can lead to better alignment results and fewer complications.

Post-Operative Care and Follow-Up

  • Managing post-operative discomfort and inflammation: Cold compresses and prescribed medications can help alleviate discomfort and inflammation.
  • Schedule and importance of follow-up visits: Regular follow-up visits are essential to monitor the surgical outcome and make any necessary adjustments.
  • Guidelines for post-surgery lifestyle adjustments: Activities that strain the eyes or involve rapid movements should be avoided during recovery.

Potential Risks and Complications

  • Infection: Though rare, infections can occur at the surgical site.
  • Adjustable suture complications: During the postoperative adjustment phase, there could be complications such as excessive tension or loosening of sutures.
  • Under or Over-Correction: While rare, there can still be minor discrepancies that may require additional adjustments.


Adjustable suture surgery offers a sophisticated and refined approach to strabismus treatment, allowing for precise and tailored outcomes. Consulting with a specialised ophthalmologist will help determine the most suitable treatment plan and approach based on the patient’s specific condition and needs.

Contact us today to schedule a consultation and discover if adjustable suture surgery could be the right solution for you or your loved one.

Author Bio

Dr Parth Shah is a leading ophthalmologist in Canberra, with a special interest in eye muscle surgery. With extensive training and experience, he is renowned for his expertise in the field. Dr Shah is dedicated not only to performing successful surgeries but also to patient education. His compassionate approach, combined with technical proficiency, has earned him the trust and gratitude of countless patients. He is a true advocate for eye health and a trusted name in the Canberra ophthalmology community.


  1. How long does it take for sutures to dissolve after strabismus surgery?
  • The dissolvable sutures used in strabismus surgery typically take around 3 – 4 weeks to dissolve completely. The exact timeframe may vary depending on the type of suture material used and the individual’s healing process.

2. Is adjustable suture surgery painful?

  • The procedure itself is performed under local anaesthesia, ensuring minimal discomfort. Postoperatively, discomfort is usually mild and can be managed with prescribed oral analgesia.

3. How long does the procedure take?

  • The surgery typically takes between 1 to 2 hours, depending on the complexity of the strabismus and the number of adjustments needed.

4. How long does recovery take?

  • Recovery time varies depending on individual cases, but most patients can resume normal activities about a week after surgery. Follow-up visits are essential to monitor the recovery process and make any necessary adjustments.

5. Is adjustable suture surgery suitable for children?

  • No, adjustable suture surgery is generally not suitable for children, as it requires the eye to be still and only local anaesthesia is used. 

6. Can I choose when the postoperative adjustment is made?

  • Typically, the adjustment is made shortly after the surgery while the patient is awake and alert. The surgeon will decide the timing based on the assessment of eye movements and the patient’s comfort.

7. Can I wear glasses after adjustable suture surgery?

  • Yes, you can continue to wear glasses as needed, but it is essential to consult with your ophthalmologist regarding any adjustments required post-surgery.

8. Will I experience double vision after surgery?

  • Some patients may experience temporary double vision after surgery as the eye muscles adjust. This condition generally resolves within a few days or weeks after surgery, and your ophthalmologist can provide guidance on managing it.

9. Is adjustable suture surgery a permanent solution for strabismus?

  • The goal of adjustable suture surgery is to provide a permanent and precise alignment of the eye muscles for optimal visual outcomes. Long-term results are generally favourable, but the need for additional adjustments or surgery may occur in some complex cases.

10. How successful is adjustable suture surgery in treating strabismus?

  • Adjustable suture surgery is highly successful in treating strabismus. Success rates vary based on the complexity of the condition and individual patient circumstances, but the majority of patients experience significant improvement in eye alignment and visual acuity.

11. What factors can affect the success of adjustable suture surgery?

  • Several factors can impact the success of the surgery, including the type and severity of strabismus, the age of the patient, the experience of the surgeon, and postoperative care. Following the recommended lifestyle adjustments and attending follow-up visits can also play a crucial role in ensuring successful outcomes.

12. Can adjustable suture surgery be performed on both eyes simultaneously?

  • Typically, adjustable suture surgery focuses on one eye at a time. However, some cases may involve bilateral procedures, and the approach can be tailored to each patient’s needs.

13. Are there any lifestyle changes I need to make after the surgery?

  • After surgery, it is advisable to avoid activities that strain the eyes or involve rapid head movements during the recovery period. Following your ophthalmologist’s guidelines and recommendations for lifestyle adjustments can enhance the overall recovery process.

14. Can I expect improved depth perception after adjustable suture surgery?

  • Improved depth perception is often a positive outcome of adjustable suture surgery for some patients. Correct eye alignment can contribute to better binocular vision and depth perception in patients who have developed normal depth perception in childhood. 

15. How soon after surgery can I resume driving?

  • The ability to drive after surgery depends on the individual’s comfort level, visual acuity, and ability to concentrate. Your ophthalmologist will provide guidance based on your recovery progress.

16. Will I experience any restrictions on physical activity after the surgery?

  • It is essential to avoid strenuous physical activities that involve rapid head movements or eye strain during the initial recovery period. Your ophthalmologist will guide you on when and how to gradually resume regular activities.

17. Can adjustable suture surgery help with both horizontal and vertical strabismus?

  • Yes, adjustable suture surgery can be effective in correcting both horizontal and vertical strabismus. The flexibility to adjust the eye muscle positioning after the initial surgery ensures that the surgical outcome is tailored to achieve optimal alignment.

18. Are there any advancements or new technologies in adjustable suture surgery?

  • Innovations and advancements in surgical techniques and technologies continue to refine adjustable suture surgery, providing enhanced precision and patient outcomes. Staying informed with your ophthalmologist about the latest developments can offer insights into potential advancements in the procedure.