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Pre-Operative Evaluation
You
will need a note from your/your child’s medical doctor before
admission to the hospital. Please bring this with you.
Laboratory work may or may not be needed. This will be done if
necessary the day before or the morning of surgery.
Sometime in the afternoon on the day prior to surgery you will be
contacted by the hospital. The time of the last feeding prior to
surgery will be reviewed. This will depend on the age of the patient
and the time of the surgery. The importance of an empty stomach prior
to anesthesia will be emphasized. All food and fluid will need to be
held after a certain hour.
Surgery
Eye
muscle surgery is designed to put the eyes in a more satisfactory
alignment. Eye muscles are attached outside the eye. Each muscle has
partner-muscles and opponent-muscles. The eyes move when one set of
muscles pull and the opposing set relaxes. “Strengthening” operations
make an individual muscle pull more effectively by shortening or
tucking the muscle to reduce its effective length. “Weakening”
operations make an individual muscle pull less effectively by moving
the two ends of the muscle closer together.
We
decide before surgery which muscles we think will be operated.
However, this may be modified at the time of surgery depending on the
manner in which the eyes may be moved passively under anesthesia.
Then, the final decision as to the most desirable approach to the eye
muscle problem is made. The operative permission therefore will
always involve permission to test and operate both eyes if necessary.
Technique of surgery
The
eye muscles lie beneath the filmy membrane (conjunctiva) covering the
white of the eyes. Incisions are made in this filmy membrane to
expose the attachment of a muscle or its tendon to the white part of
the eye. These tendons are then moved in a way to make the muscle
effectively longer or shorter. The muscles are reattached to the
white part of the eye (sclera) by stitches. These stitches are
usually absorbable material not requiring removal. Following surgery
the area of the incision in the filmy membrane and the point where the
sutures are placed, may exhibit some redness and swelling. The
eyelids are usually not manipulated, but occasionally following
surgery the eyelids maybe are temporarily discolored or swollen.
Tears are usually tinged with blood the first day; tears and
secretions tend to dry and collect on the eyelids.
Results of eye muscle surgery
Eye
muscle surgery is not an exact science. It is based upon average
responses to “shortening” or “lengthening” a given muscle a set number
of millimeters. The average response to shortening or lengthening an
eye muscle is predictable. However, there may be an over-response or
under-response to any given surgery.
In
most instances we plan to achieve with one procedure a satisfactory
correction of the eye muscle problem. Because of varying responses,
or because of the magnitude or complicated nature of any given muscle
problem, more than one operation may be necessary. It is important
not to evaluate the outcome of the surgery during the first several
weeks following surgery. The operated muscles do not function with
full power immediately. Until full function is regained, the eye
position may change frequently. It may take up to six to twelve weeks
to regain full function.
Recovery room
Following muscle surgery the patient is taken to the recovery room
where special nurses and equipment are available. Here the recovery
from anesthesia is supervised. When a satisfactory state of
consciousness returns, the patient is sent to a separate room. The
family can rejoin the patient at this time.
Post-Operative Care
Eating: Until the patient is well awake nothing by mouth should be
encouraged. Once awake, the patient may have ice chips or small sips
of a beverage. Nausea may occur after the administration of
anesthesia. Large quantities of food should be avoided in the
immediate post-operative period as they can irritate the stomach.
Usually the patient is able to resume a regular diet the day following
surgery.
Bandages: The eyes are not covered. There may be a small amount of
discharge. The discharge may be tinged with blood. Secretions can be
gently wiped away with a moist tissue.
Tearing: Tearing may occur the first few days after surgery. If it
is bothersome, they can be gently wiped away with a tissue or other
soft material like a towel.
Pain: Generally there is little or not pain except on extreme
movements of the eyes. The patient learns this and tends to move the
head rather than move the eyes.
Activity: The patient is able to use the eyes the day of surgery.
All patients are allowed up with supervision the same day. Infants
and small children may be held in the parents’ arms. Swimming is not
permitted for one week. Keep soap and water out of eyes while
bathing.
Glasses: The eyes may be light sensitive following surgery. In this
case, older patients will appreciate sunglasses or wide-brimmed hats.
Younger patients may choose to close their eyes to avoid the light.
If glasses are worn before surgery, they will probably be continued
immediately after surgery. They may be modified at some time during
the post-operative period.
Medications: Any regular medication that the patient is taking should
be continued upon leaving the hospital. Occasionally, special
additional medicines will be prescribed for you to take home. We
instill an ointment into the eyes after surgery. You will be given
some of this ointment to take home. A small amount of this is to be
placed inside the lower eyelids nightly for the first week. On the
day of discharge from the hospital this is not necessary.
Office visits: Generally the first checkup after surgery is within
the first week. Regular visits will then be scheduled at certain
intervals. If there is any problem between scheduled visits please
report that and additional visits will be arranged.
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