What to Expect During Your Examination?
First, we inquire if the patient has noticed any double vision or eye misalignment. We ask for characterization of the diplopia and/or eye deviation:
What percentage of the day does it occur?
- Is it worse when viewing in a particular direction?
- Is it more pronounced when looking far or near?
- Is it improving or worsening?
- Are images displaced horizontally, vertically, or diagonally?
You may also describe any other observations such as an anomalous head position, squinting, or abnormal eye movements. We will review the family history, current health history, medications, and medication allergies. One of our specially-trained technicians checks the vision (be sure to bring glasses and/or contact lenses), confrontation visual fields (in adults), pupils, and depth perception. For adults, a refraction is performed to determine the best corrected vision before the intraocular pressure is checked.
Dr. Shin then measures the patient’s ocular alignment using special ophthalmic prisms. Dilating drops are instilled. In general, it takes 20 minutes for an adult’s eyes to dilate, and they will remain dilated for approximately 4-6 hours. Dilating drops temporarily increase sensitivity to bright lights and diminish near vision.
Several specialized microscopes are used to examine the eyelids, the surface, and inside of the eyes. She discusses the alignment of your eyes and the treatment options/plans (glasses with or without prisms, BOTOX, eye exercises, or surgery). Any questions you have will be answered. A glasses prescription, including recommendations for special lenses, tint, or coatings, may be written.
Eye Muscle Surgery = Strabismus Surgery
There are six extraocular muscles that attach to each eye and synergistically or antagonistically to control eye movement, alignment, and rotation. Misalignment of the eyes can occur congenitally, after trauma, with systemic diseases, brain tumors, cranial nerve palsies, and compensation for other vision problems such as farsightedness. After carefully assessing head position, measuring ocular alignment in all gazes at distance and near, and assessing a person’s ability to use his/her eyes together (binocularly), Dr. Shin ascertains whether exercises, prisms (mounted on or ground into glasses), a BOTOX injection, or strabismus surgery is the best option for the patient. If strabismus surgery is the recommended treatment, she devises the best plan to align the patient’s eyes, especially straight ahead at distance and near, but also in other directions of gaze (so the patient can regain optimal function of his/her eyes).
The surgery is performed on an outpatient basis at an ambulatory surgery center. An anesthesiologist administers a general anesthetic and monitors the patient’s vital signs. During the surgery, the eye is never removed. The globe is rotated so Dr. Shin can approach and operate on the appropriate eye muscle(s). Then, small incisions are made on the clear membrane covering the white part of the eye. Through the incisions, the appropriate eye muscle(s) is/are isolated on the surface of the eye and the tension of it/them is increased or decreased to eliminate the strabismus. The inside of the eyeball is not entered during this type of surgery. Dr. Shin’s eye muscle surgery techniques include the best combination of eye muscle weakening, strengthening, and other specialized treatments.
The earlier in life strabismus surgery is performed in children the better the chance of achieving binocular vision in both eyes.
Adjustable Suture Surgery for Adults
Adjustable sutures may be placed at the time of an adult patient’s surgery. These sutures allow Dr. Shin to fine tune eye muscle position in the office on the first post-operative day, after the surface of the eye is anesthetized with eye drops. The adjustable suture is permanently tied down once the desired alignment is achieved. These sutures are particularly helpful when there is scarring from previous eye surgery (strabismus, glaucoma, and retina), inflammation from eye muscle diseases, neurological weakness, or a less predictable outcome because of prior strabismus surgery(ies). This technique can greatly enhance the surgical outcome.
Despite having the appropriate surgery, some patients may require further eye muscle surgery in the months, years, or decades following their initial operation to refine their ocular alignment.
Recovery from Strabismus Surgery
Some sleepiness may persist after awakening from the general anesthetic. You may drink and eat as tolerated although temporary nausea or vomiting is possible. Crusting of the eyelids and blood-tinged tears are normal following strabismus surgery. Discomfort is usually controlled with Extra Strength Tylenol. Some patients experience light sensitivity and foreign body sensation from the dissolvable sutures postoperatively. Adults sometimes complain of headaches or eye soreness. Patients approximately three and older may see two images even with excellent alignment as their brain adjusts to the new position of their eyes. Diplopia, if it occurs, may last for seconds up to weeks. Most working adults are able to return to work four days after surgery.
Combination antibiotic-steroid eye drops are used four times a day for 2 weeks after surgery. Dr. Shin checks your eye alignment and healing in the office the day after surgery, one week later, and six weeks post operatively.