Pediatric ophthalmologists at Hassenfeld Children’s Hospital at NYU Langone recommend surgery to correct lazy eye, or amblyopia, in certain situations. If your child was born with a cataract, which obstructs or clouds vision in one or both eyes, the doctor may perform surgery to remove it. Surgery is also performed to correct strabismus, or crossed eyes.
Children born with a cataract, or cloudy lens, are more likely to develop lazy eye. If vision in one eye is blocked, the brain favors the stronger eye and the affected eye becomes weak.
The lens of the eye, which focuses light on the retina, consists of mostly water and protein. This protein usually helps to keep the lens clear and lets light pass through it. However, pieces of the protein can clump together and cause the lens to become cloudy. Cataract surgery entails removing the cloudy lens.
Surgery may be a good option for children whose eyesight is threatened by a cloudy lens. The procedure is usually performed in the hospital—with general anesthesia—while your child is an infant to avoid any permanent vision damage.
In children younger than six months, the cloudy lens is removed and replaced with eyeglasses, which enable the eye to focus light onto the retina. Children may receive a lens implant to replace the eyeglasses when they are older.
In children older than six months, an artificial lens implant, known as an intraocular lens, replaces the cloudy one. You and your child’s doctor determine the right age for an implant.
Some children with lazy eye due to strabismus may not experience any improvement with nonsurgical therapies such as eyeglasses or eye patches. They may require surgery to realign the eyes and correct the amblyopia.
Strabismus surgery is an outpatient procedure performed to repair the muscles responsible for crossed eyes. While surgery can be performed for cosmetic purposes in adults, it can also help restore depth perception. Many adults gain some improvement in depth perception after surgery.
In children and adults, surgery is performed using general anesthesia. Surgery can last anywhere from a few minutes to an hour, depending on whether one or both eyes need correction. The ophthalmologist identifies which muscles need correction, and either tightens them during a procedure known as a muscle resection or loosens them in a muscle recession.
During the procedure, an instrument called a lid speculum keeps the eye open. The surgeon makes a small incision in the conjunctiva, the thin layer of tissue that covers the eye muscles. If the surgeon is performing a muscle resection, he or she removes a section of the muscle to shorten it. The surgeon moves the muscle, then reattaches it closer to the back of the eye.
In adults, a surgeon may use an adjustable suture, which allows him or her to shorten or lengthen the muscle for additional alignment of the eye within 24 hours of the surgery. Doctors generally use this type of suture if the precise position of a fixed suture is difficult to determine due to scarring or inflammation.
Two hours after surgery, when you’re awake, you’re given eye drops to numb the eyeball before your doctor makes any needed adjustments.
After the procedure is over, you or your child remain in the recovery room for a few hours before going home. There may be soreness and redness in the eye, and these symptoms may last for several weeks.
Rarely, complications occur. They include diplopia, or double vision; infection; bleeding; muscle detachment, meaning the muscle adjusted during the procedure comes loose; and scarring.
To help prevent infection, doctors may give people who have this surgery antibiotics and steroid drops, which are taken anywhere from a few days to a few weeks.
Some people may need to wear glasses indefinitely to see properly. Others may experience a recurrence of strabismus and may require more than one surgery. If the eyes cross in the middle, only one surgery may be necessary. If one or both of the eyes drift outwards, there is a greater chance that another surgery may be necessary.
Although surgery may improve your child’s appearance, he or she may not experience an improvement in vision. This is because the brain controls the eyes, and eye muscle surgery does not directly address atrophied nerve pathways between the eye and the brain. A repeat procedure, however, may help to improve vision by further adjusting the muscle.
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