Strabismus Surgery for Children: What Parents Need to Know

Introduction to Strabismus

Ever noticed when one of your eyes decides to go on its own adventure, looking in a different direction than the other? That’s what we call strabismus, or “crossed eyes.”

Lots of kids have it, and there are multiple ways to help your kids’ eyes to team up better. Sometimes, it’s as simple as wearing glasses or doing fun exercises. In other cases your doctor might suggest eye muscle surgery.

Strabismus Surgery for Children: What Parents Need to Know

Different types of strabismus

  1. Esotropia: This is when one eye turns inward, towards the nose.

2. Exotropia: Here, one eye drifts outward, away from the nose.

3. Hypertropia: This is when one eye looking up while the other stays straight.

4. Hypotropia: It’s the opposite of hypertropia. One eye looks downward while the other stays straight.

5. Cyclotropia: Most commonly, it is due to one eye rotating outwards or inwards around its visual axis.

Understanding strabismus (eye muscle) surgery for children

  1. Paediatric evaluation: Before considering surgery, a thorough assessment is conducted by a paediatric ophthalmologist to determine the type and severity of strabismus. This evaluation may include visual acuity testing, eye alignment measurements, and assessment of eye movements. Additionally, factors such as the child’s age, overall health, and potential impact on vision development are carefully considered.
  2. Pre-operative preparation: Parents and caregivers are provided with detailed information about the surgical procedure, including its purpose, potential risks, and expected outcomes. Pre-operative instructions may include guidelines for fasting before surgery, discontinuation of certain medications, and preparing the child psychologically for the experience. Child-friendly explanations are offered to help alleviate any fears or anxieties.
  3. Anesthesia: Paediatric eye muscle surgery is typically performed under general anesthesia to ensure the child’s comfort and safety during the procedure. Anesthesia is administered by a specialised paediatric anesthesiologist who monitors the child’s vital signs throughout the surgery.
  4. Surgical technique: The surgical approach may vary depending on the specific type and severity of strabismus. During the procedure, the surgeon makes small incisions in the tissue covering the eye (conjunctiva) to access the eye muscles. Using delicate instruments and precise techniques, the surgeon adjusts the tension or position of the affected eye muscles to achieve proper alignment. Special consideration is given to preserving and optimising visual function and ocular motility.
  5. Adjustable sutures: In some cases, adjustable sutures are used during paediatric eye muscle surgery. These sutures allow for fine-tuning of eye alignment in the immediate postoperative period, ensuring optimal results. This approach minimises the need for additional surgeries and maximises the likelihood of achieving the desired outcome.
  6. Post-operative care: After surgery, the child is closely monitored for any signs of discomfort, inflammation, or complications. Eye drops or ointments may be prescribed to prevent infection and promote healing. Parents are provided with post-operative care instructions, including guidelines for eye hygiene, activity restrictions, and follow-up appointments.
  7. Recovery and rehabilitation: The recovery process varies for each child but typically involves a period of rest and gradual return to normal activities. Vision therapy or eye exercises may be recommended to help the child adjust to the new alignment and improve visual function. Regular follow-up visits are scheduled to monitor progress and make any necessary adjustments.

What are the options in strabismus treatment?

When it comes to treating strabismus in children, several options are available, tailored to each child’s unique needs. Here’s a breakdown:

  1. Observation and monitoring: In some cases, especially with mild forms of strabismus or intermittent deviations, the ophthalmologist may recommend a period of observation without immediate intervention. Regular monitoring allows the doctor to assess changes in eye alignment and visual function over time.
  2. Spectacles: Corrective lenses, such as spectacles or contact lenses, may be prescribed to address refractive errors (e.g., nearsightedness, farsightedness) that contribute to strabismus. By providing clear vision, eyeglasses can help reduce eye strain and promote more comfortable binocular vision.
  3. Vision therapy: Vision therapy, also known as orthoptics or eye exercises, is a non-surgical approach aimed at improving eye coordination, focusing abilities, and depth perception. Through a series of customised exercises and activities, children learn to control their eye movements and develop better visual skills.
  4. Patch therapy: Patching involves covering the stronger eye with an adhesive patch to encourage the use of the weaker eye. This treatment, known as occlusion therapy, is often used to treat amblyopia (lazy eye) associated with strabismus. By stimulating visual development in the weaker eye, patching helps restore balanced vision.
  5. Prism lenses: Prism lenses are special eyeglass lenses that can help compensate for eye misalignment by bending light rays. By altering the angle of incoming light, prism lenses can help reduce double vision and improve visual comfort for children with certain types of strabismus.
  6. Botulinum toxin (Botox) injections: In some cases, especially when strabismus is caused by muscle imbalances, botulinum toxin injections may be used as a temporary treatment. Botox injections can selectively weaken overactive eye muscles, allowing the opposing muscles to regain control and restore eye alignment. This approach is often considered for children who are not suitable candidates for surgery or as a preoperative measure to improve surgical outcomes.
  7. Surgery: Eye muscle surgery is a common treatment option for children with persistent or severe eye misalignment that does not respond adequately to non-surgical interventions. During surgery, the ophthalmologist adjusts the position or tension of the eye muscles to bring the eyes into proper alignment. Surgery may be performed on one or both eyes, depending on the specific needs of the child.
  8. Combination therapy: In many cases, a combination of treatments may be used to address various aspects of strabismus and optimise visual outcomes. For example, a child may undergo vision therapy to improve eye coordination before or after strabismus surgery, or patching therapy may be combined with eyeglasses to treat amblyopia.

Preparing for strabismus surgery 

Preparing your child for eye muscle surgery involves both practical and emotional considerations to ensure a smooth and comfortable experience. Here’s a comprehensive guide:

  1. Consultation with the ophthalmologist: Before surgery, schedule a consultation with the ophthalmologist to discuss the procedure in detail. This is an opportunity to ask questions, address concerns, and gain a thorough understanding of what to expect.
  2. Explaining the procedure: Use age-appropriate language to explain the surgery to your child. Describe it as a special operation that will help their eyes work better together. Reassure them that the doctors and nurses will take good care of them.
  3. Touring the hospital: If possible, arrange a visit to the hospital or surgical center where the procedure will take place. Familiarise your child with the environment, including the preoperative area, operating room, and recovery area. Meeting the surgical team can help alleviate anxiety and build trust.
  4. Discussing anesthesia: Explain to your child that they will receive medicine to help them sleep during the surgery. Emphasise that they won’t feel any pain and that the doctors will wake them up when it’s all done.
  5. Addressing fears and concerns: Encourage your child to express any fears or concerns they may have about the surgery. Listen attentively and provide reassurance. Offer age-appropriate books or resources that explain surgery in a positive and relatable way.
  6. Preparing for the hospital stay: Pack a bag with comforting items from home, such as a favorite stuffed animal, blanket, or book. Bring snacks and activities to keep your child occupied during the waiting periods before and after surgery.
  7. Following preoperative instructions: Follow any instructions provided by the surgical team regarding fasting before surgery, medication schedules, and bathing or hygiene protocols. Ensure that your child follows these instructions to minimise the risk of complications.
  8. Emotional support: Offer plenty of love, encouragement, and reassurance to your child in the days leading up to the surgery. Be patient and understanding, and validate their feelings. Remind them that squint surgery is a positive step towards better vision and eye health.
  9. Post-operative care: Familiarise yourself with post-operative care instructions provided by the surgical team. Ensure that your child receives any prescribed medications, follows activity restrictions, and attends follow-up appointments as scheduled.

Follow-Up care after strabismus surgery

After eye muscle surgery, it’s natural for both you and your child to have questions about what to expect during the recovery period. Here’s a guide to help you navigate the post-operative phase:

  1. Immediate recovery: After the surgery is complete, your child will be taken to a recovery area where they will gradually wake up from anesthesia. It’s normal for them to feel groggy or disoriented initially, but this should improve as the effects of anesthesia wear off.
  2. Monitoring vital signs: The medical staff will monitor your child’s vital signs, such as heart rate, blood pressure, and oxygen levels, to ensure they are stable and comfortable. They will also assess your child’s response to anesthesia and pain management.
  3. Managing discomfort: Your child may experience mild discomfort, redness, or swelling around the eyes following surgery. This can usually be managed with over-the-counter pain relievers recommended by the surgeon or prescribed medication. Applying cold compresses to the eyes can also help reduce swelling and discomfort.
  4. Temporary changes in vision: It’s common for children to experience temporary changes in vision after strabismus surgery. This may include blurry vision, double vision, or difficulty focusing. These symptoms typically improve as the eyes heal and adjust to their new alignment.
  5. Activity restrictions: Your child may be advised to avoid strenuous activities, swimming, or rubbing their eyes in the days following surgery. It’s essential to follow any activity restrictions provided by the surgeon to prevent strain or injury to the eyes during the healing process.
  6. Follow-Up appointments: Your child will need to attend follow-up appointments with the surgeon to monitor their progress and assess the outcome of the surgery. These appointments are an opportunity to address any concerns, track visual improvements, and make any necessary adjustments to the treatment plan.
  7. Gradual improvement: While the immediate effects of strabismus surgery may be noticeable, it’s essential to understand that the full benefits of the procedure may take time to manifest. Your child’s eyes may continue to improve in alignment and coordination over several weeks to months following surgery.
  8. Emotional support: Surgery can be a significant event for both children and parents. It’s normal for your child to feel a range of emotions, including anxiety, fear, or frustration, during the recovery period. Offer plenty of love, encouragement, and reassurance, and be patient as they adjust to the changes in their vision.
  9. Communication with the surgical team: Maintain open communication with the surgical team and don’t hesitate to reach out if you have any questions or concerns during the postoperative period. They are there to support you and ensure the best possible outcome for your child.


  1. What age is appropriate for eye muscle surgery in children? 

Eye muscle surgery is typically performed in children aged between 6 months and 4 years old. However, it can also be done in older children and adults.

2. How long does strabismus surgery take? 

The duration of strabismus surgery varies depending on the complexity of the case, but it typically takes around 1 to 2 hours.

3. Is eye muscle surgery painful?

Eye muscle surgery is performed under general anesthesia, so the patient will not feel any pain during the procedure. Some discomfort may be experienced during the recovery period.

4. Are there any dietary restrictions before or after surgery? 

Your surgeon will provide specific instructions regarding dietary restrictions before and after surgery. Typically, patients are advised not to eat or drink anything for a few hours before the procedure if general anesthesia is required.

5. Can eye muscle surgery completely correct the eye misalignment? 

In many cases, eye muscle surgery can significantly improve eye alignment, but it may not always completely correct the misalignment. Additional treatments or surgeries may be necessary in some cases.

6. How soon can children resume normal activities after surgery? 

Children can usually resume normal activities within a few days to a week after surgery, depending on their individual recovery process. Your surgeon will provide specific guidelines based on your child’s condition.

7. Will my child need to wear an eye patch after surgery? 

Your surgeon will provide specific instructions regarding post-operative care, including whether your child will need to wear an eye patch and for how long.

8. What are the most common complications of eye muscle surgery?

While complications are rare, possible risks of eye muscle surgery include infection, bleeding, overcorrection or undercorrection of the misalignment, and temporary or permanent changes in vision.

9. What should I do if I notice changes in my child’s vision after surgery?

If you notice any changes in your child’s vision after eye muscle surgery, such as worsening misalignment or decreased visual acuity, contact your ophthalmologist immediately for further evaluation and guidance. Early intervention can help address any issues and prevent complications.


Eye muscle surgery for children, usually done between 6 months and 4 years, lasts 1-2 hours under general anesthesia. Recovery discomfort is common, with most returning to normal activities within a week. Alternative treatments may be considered, but surgery can significantly improve eye alignment. Regular follow-up appointments are necessary for monitoring. Support from groups and adherence to post-operative care instructions are essential for success. With proactive involvement, parents can ensure improved eye alignment and well-being for their child.

Author Bio

Dr. Parth Shah is an experienced ophthalmologist in Canberra, Australia specialising in eye muscle surgery. With a commitment to promoting children’s eye health, Dr. Shah aims to spread awareness about the importance of early detection and treatment of eye conditions like strabismus. He believes that a proactive approach to eye care can make a significant difference in a child’s life.