During strabismus surgery, the sutures are removed. Surgery to correct strabismus: types

Surgery for strabismus is recommended by a doctor if conservative methods treatments do not give a positive effect. Tactics surgical intervention determined individually, based on the degree of deviation eyeball, states muscular apparatus. The effectiveness of surgical intervention reaches 90%.

Eye surgery to eliminate their deviation is not the primary method of treatment. If it was prescribed by a doctor, you should not postpone it, since it is impossible to fix the problem in other ways. Due to untreated strabismus, vision is gradually lost.

The purpose of the operation to correct strabismus in children and adults is to eliminate a cosmetic defect, to restore binocular vision. Depending on whether there is a deviation of one or both eyes, a unilateral or bilateral operation is performed.

Surgery for strabismus is more often performed in children aged 4-6 years. For children with congenital strabismus, a large angle of deviation, bilateral lesions, surgical intervention is indicated regardless of age.

The surgical method is corrected taking into account the same indications, as well as at the request of the patient himself.

Operation types

There are two types of strabismus surgery:

• reinforcing - aimed at strengthening the muscle that cannot hold the eyeball in the correct position;
• weakening - suppression of the action of more strong muscle, which deflects the eyeball.

Relaxing surgery for strabismus is performed by moving or cutting the muscle. To strengthen the muscle, it is shortened.

Preparatory stage

Before choosing operational method doctor performs strabismus treatment comprehensive examination patient:

• general clinical tests;
• grade functional state organ of vision;
• if necessary, appoint consultations of narrow specialists.

Special preparation is not required. If the operation is performed on a child, the last meal should be no later than 12 hours before the intervention. This condition is necessary for general anesthesia.

When a pronounced spasm is detected oculomotor muscles recommend doing special exercises for a month. They allow the muscles to relax and take the most natural position.

How is strabismus surgery done?

The surgical method of treating strabismus is selected taking into account the characteristics of the disease. Operations to eliminate strabismus are called according to the technique.

1. Recession. The oculomotor muscle is dissected at the site of its attachment, sutured to the sclera. The tension force decreases, the eyeball takes the correct position.
2. Myectomy. Dissection of the muscle without subsequent suturing.
3. Muscle resection. Due to shortening, the muscle fiber shifts the eyeball in its direction.

The surgeon uses a laser or radioknife. These devices are the least traumatic, provide an instant stop of bleeding.

In an adult, surgery is usually performed with local anesthesia. General anesthesia is recommended for strabismus surgery in a child. The adult is allowed to go home a few hours after surgical intervention. In children, the operation takes place in a hospital, then they are left under observation for 1-2 days.

The operation to correct severe strabismus in children takes place in two stages.

1. Reducing the angle of strabismus should be carried out as early as possible. This is done at 12-14 months, when the child is able to endure anesthesia.
2. The final correction of strabismus is carried out at 4-5 years of age.

Between stages surgical correction carried out conservative treatment.

The operation will be free if you do it according to compulsory medical insurance policy at the state clinic. If you go to a private hospital, surgery will cost 15,000-30,000 rubles.

Video: Surgical correction of strabismus

Rehabilitation stage

Immediately after the procedure, swelling and redness of the eye are observed, possible pain. This condition lasts 3-5 days, then the symptoms disappear. Full recovery of vision functions lasts about 4 weeks.

After strabismus surgery, you need to perform rehabilitation measures:

• visual gymnastics;
• instillation of vitamin eye drops;
• the use of antihistamines, anti-inflammatory drugs, if necessary, analgesics;
• use of tinted glasses or a bandage.

Once a week you need to see an ophthalmologist. Postoperative Recovery implies a limitation physical activity. For a month, patients are advised not to play sports, not to visit a bath or sauna. The child is exempt from physical education at school.

It is recommended to do daily throughout the year. They help strengthen muscles, prevent the recurrence of the disease. If there is a decrease in vision, the baby is selected corrective glasses or lenses.

Possible Complications

Surgical intervention in most patients passes without adverse consequences. Possible complications:

• injury vagus nerve, which leads to disruption of the heart, lungs, esophagus;
• hypercorrection - excessive change in muscle length;
• scar formation on muscle tissue;
• damage to the eyeball.

Recurrence of the disease during surgical treatment is rare. Strabismus may return if the patient does not perform rehabilitation measures, ignores visits to the ophthalmologist. Reoperation cannot be done within six months after the first.

A rare form of strabismus is. In this disease, there is a congenital dysfunction of the oculomotor nerves. The eye is not able to turn towards the temple. Even surgery does not give a positive effect. It is used only to reduce the severity of symptoms.

Or strabismus - a defect of the irritant system, in which there is a deviation of one or both eyes when looking straight. This pathology can occur both in children and in adulthood. Treatment should be comprehensive.

cool

Send

Whatsapp

Strabismus and its consequences

Strabismus requires immediate treatment. In its absence, amblyopia develops, bilateral visual impairment and double vision. In addition to health problems, the patient develops a number of complexes that will interfere with his normal life.

Causes

Exist a large number of causes of strabismus. Congenital pathology occurs against the background of:

• abnormal development of the embryo;
• premature birth;
• genetic factor;
• congenital cataract.

Acquired deviation occurs under the influence of a number of negative factors and concomitant diseases. The main reasons for the development of strabismus:

• oncology of the retina;
• thorn;
• paralysis of the eye muscles;
• high pressure;
• brain injury;
• diabetes;
• thyroid disease;
• atrophy of the optic nerve;
• encephalitis;
• astigmatism;
• cataract.

Often observed in patients with a severe psychological condition.

Symptoms

Symptoms directly depend on the type of pathology. Strabismus can be paralytic and concomitant. In the first case, strabismus occurs against the background of paralysis of one of the muscles of the eye. As a result, one eyeball deviates from the axis.

The patient ceases to perceive the image with both eyes. There are frequent headaches and dizziness. A person cannot determine the location of a particular object.

In the case of concomitant strabismus, both eyes can move in all directions. There is no double vision in the eyes. When trying to focus on an object, both eyes deviate to the side.

Strabismus can be accompanied by myopia, farsightedness, astigmatism and other disorders. visual system. In some cases, strabismus may not appear at all.

Classification

There are two main ones: friendly and paralytic. The first type most often occurs in patients with ametropia and anisometropia. With a paralytic type of deviation, double vision and a violation binocular vision. This type of pathology can occur as a result of trauma, toxicosis or severe poisoning.

There are also the following forms of strabismus:

1. convergent. The eye is directed towards the bridge of the nose. Often occurs against the background of farsightedness.
2. Divergent. It is combined with myopia, while the eye is directed to the temple. The cause may be a brain disease, fright or infection.
3. Vertical. The eyeball can squint up or down.

Atypical forms are very rare. They are caused by anatomical anomalies in development. For example, Down syndrome or Brown syndrome.

By stability, strabismus can be permanent or permanent.

Diagnostics

Only an ophthalmologist can make an accurate diagnosis. For this, a visual examination is carried out and the causes of the disease are established. The examination involves checking visual acuity, determining the angle of strabismus and assessing eye friendliness using special mirrors. The doctor studies the mobility of the organs of vision in different directions.

To confirm the diagnosis, a consultation with a neurologist is necessary. Treatment for strabismus begins at diagnosis and can last 2 to 3 years. In some cases, it is impossible to completely get rid of the defect, but only to improve the patient's condition.

Treatment Methods

Treatment methods for strabismus can be divided into traditional and surgical intervention. Under traditional treatment implies a number of techniques aimed at normalizing the oculomotor function of the muscle and increasing visual acuity.

Expert opinion

Slonimsky Mikhail Germanovich

Ophthalmologist of the highest qualification category. He has vast experience in diagnosing and treating eye diseases in adults and children. Over 20 years of experience.

Therapeutic treatment involves occlusion and hardware exposure. The first option is to wear special stickers and occluders that help integrate both eyes into the visual process. The mode of wearing such products is determined by the doctor, after a thorough examination of the patient.

Hardware therapy normalizes visual functions with the help of targeted complex stimulation. For this, modern high-tech devices are used.

Surgery appointed in case of inefficiency traditional methods therapy. The operation allows you to restore a symmetrical or close to symmetry position of the eyes by normalizing the muscle balance.

As an additional technique or prevention, eye gymnastics is performed. A set of exercises is selected by the doctor. Most often, these are various exercises with a cord, pictures or a flashlight.

Surgical therapy is based on the weakening or strengthening of the muscles that are responsible for the movement of the eyeball. With severe strabismus, several surgical interventions may be required at once.

Surgery is performed on an outpatient basis. The need for hospitalization depends on the patient's condition and the recommendations of the surgeon. Most people return to their normal lives a few days after surgery.

Indications

For adults, the operation is performed at any age, for children - from 6 years. In some cases, the doctor may decide that strabismus surgery is needed at an earlier age.

Indications include a violation of binocular vision and the ineffectiveness of conservative therapy.

In what cases can you be denied?

The specialist may refuse to perform surgery. This is possible if the patient has an acute disease. Contraindications include the presence of infectious lesions respiratory tract: runny nose, cough and other symptoms.

Types of surgery

Strabismus can be treated with several types of surgery. Depending on the indications, it is carried out:

• suturing the oculomotor muscle to the tendon or sclera;
• myectomy - cutting the muscle, without suturing;
• resection of a part of the muscle - removal of the excess part of the muscle fiber;
• folds in the muscle.

The essence of the intervention is that a too long muscle is shortened, and a short one is lengthened.

Training

The operation is performed under anesthesia and on an outpatient basis. The patient should come on an empty stomach, at least 6 hours after the last meal. In the case of a morning operation, it is forbidden to drink and eat after midnight. If the procedure is scheduled for the afternoon, then a light breakfast is allowed, but no later than 8 am.

1-2 weeks before surgery, you need to undergo the following examinations:

• HCV study;
• morphology with smear;
• analysis of the level of potassium and sodium in the blood;
• blood clotting time;
• sugar analysis;
• analysis for the presence of HBS antigen.

In the presence of concomitant diseases are prescribed additional research and consultations with other specialists. Patients over 40 years of age need to undergo an EKG study with a description, and after 60 years an RTG study is prescribed chest with description.

Before surgery, it is recommended to be vaccinated against hepatitis B. A safe level of antibodies is observed in the second week after the second dose of the drug. The third vaccination protects the body for more a long period- from 5 to 8 years. The effectiveness of vaccination is determined by analyzing the level of antibodies.

How is the procedure carried out?

For the operation, it is necessary to ensure complete immobility of the eye muscles. For adults, the intervention is performed under local anesthesia, and for children - under general anesthesia.

Stages of implementation:

1. Applying a special mask on the face with slits for the eyes.
2. Fixation of the eyelids with spacers.
3. Gaining access to eye muscles through an incision in the sclera.
4. Muscle length adjustment.
5. The imposition of suture material.

The probability of maintaining the pathology after surgery is 10-15%. To save the result and avoid complications, it is necessary to properly carry out the restoration.

Recovery period

In the first few days after surgery, the operated eye may appear red and swollen. Temporary visual impairment is also considered normal. Because of the seams, there is a sensation of a foreign object in the eye.

To avoid the development of complications, a sparing regimen must be observed after the operation.

During the first weeks, anti-inflammatory drugs are needed. Most often, Tobradex is prescribed 3 times a day, 1 drop. Purulent discharge should be removed by rinsing with warm boiled water.

The first control is carried out a week after the intervention. The doctor evaluates the healing process and, if necessary, prescribes additional medicines. Further control is appointed for 2-3 months.

What Not to Do

You can't swim for a month after the operation. You need to protect your eyes from pollution. For 2-3 weeks you need to abandon physical activity. If the correction of strabismus was carried out in a child, then he is given an exemption from physical education lessons for a period of six months.

Possible Complications

Immediately after the correction, the patient may experience double vision. This is normal phenomenon which goes away on its own in 2-3 days. In most cases, surgery to correct strabismus goes without complications. However, it is not always possible to get a 100% result after the first intervention. In some cases, multiple procedures are required.

To the number possible complications include reduced vision, misalignment of the eye axis, or an adverse reaction to anesthesia. There is also a risk of infection.

Useful video

Strabismus. How to return the "straight" look:

Price

The cost of treatment depends on many factors. The price for the operation is indicated for one eye. On average, surgery will cost about 27,500 rubles. Correction of paralytic strabismus will cost 82,500 rubles.

- pathology of the oculomotor muscles, in which the eyeball is displaced from its normal location. As a result, a cosmetic defect is formed, a decrease in visual acuity of the affected organ.

Indications for surgery

Most often, strabismus is detected in the early childhood. In this case, the operation is not carried out immediately. First, any doctor will advise you to use conservative methods of treatment. But there are cases when surgical intervention is indispensable:

• a strong angle of deviation of the eyeball from its normal location in the orbit;
• lack of effectiveness from a conservative method of treatment;
• lack of desire in the patient to carry out long-term conservative treatment, the need to get the effect immediately;
• high risk development of amblyopia a sharp decline vision function of one eye, as a result of which it is completely turned off.

Before the procedure, you must obtain permission from the attending physician.

Depending on the type of pathology of the oculomotor muscles, 2 types of operations are distinguished:

• reinforcing - tension and strengthening of muscle tissue, due to which it will be able to hold the eyeball;
• weakening - a decrease in the tension of the oculomotor muscle, due to which the eye strongly deviates to the temple area.

During augmentation surgery, the oculomotor muscles are incised and pulled, then sewn back. If, on the contrary, the muscle is very tense, it is cut in a certain place so that it is less stretched.

Procedures are divided depending on the method of surgical intervention:

• recession - an incision in the oculomotor muscle and further suturing to the sclera, resulting in a normal tension;
• myomectomy - dissection of muscle tissue in a certain place to reduce tension without subsequent stitching;
• resection - the surgeon completely excised part of the muscle, stitching the two extreme sides.

The choice of surgical intervention depends on the diagnosis of the patient.

In order for the ophthalmologist to make an accurate diagnosis and give permission for the operation, it is recommended to conduct the following ophthalmological examinations:

• assessment of visual acuity using diagnostic tables;
• Ultrasound of the eyeballs;
• assessment of the angle of deviation of the affected eye from the normal location.

Before surgery, the patient must pass the following tests:

• general clinical analysis of blood and urine, blood biochemistry;
• if necessary, a coagulogram;
• analysis for HIV and hepatitis C;
• fluorography;
• electrocardiogram.

In addition, it is necessary to undergo an examination and obtain permission from doctors of narrow specialties: a neurologist, a cardiologist, an otolaryngologist, a dentist. If all tests are normal, the ophthalmologist may give permission for the operation.

Also, before the operation, the patient must comply with a number of rules:

• for a week you can not use new drugs that the doctor was not warned about;
• do not drink alcohol two days before the operation;
• before the procedure, you must take a shower, wash your face and hair thoroughly.

Special preparation for the organs of vision is not required. You should arrive at the clinic at the time prescribed by the doctor. If any of these rules is violated, it can lead to consequences, complications during or after the operation.

Surgery is carried out in several stages:

1. the patient lies on the couch, a disposable cap is put on the hair;
2. make a general or local anesthesia, the latter option can only be applied to adults;
3. using a scalpel, access the oculomotor muscles;
4. if the muscle is not stretched enough, it is dissected and sewn in the desired position;
5. if the muscles are stretched excessively, they are notched, but not sewn;
6. tissue closure, application of an antibacterial and anti-inflammatory agent.

It is possible to carry out the operation without incision of the oculomotor muscles. In this case, it is pulled and sewn in the required position. Tissue healing in this case is faster.

Rehabilitation and recovery

After the operation is completed, rehabilitation period. If the procedure was performed on an adult, he is kept in a clinical facility for several hours, then he is allowed to go home if there are no complications. Children should stay in the hospital for 1-2 days. At home, you must do the following:

• application medications prescribed by the doctor (antibacterial, anti-inflammatory, moisturizing drops);
• on the first day after the operation, a long rest and sleep;
• wearing sunglasses outdoors when exposed to bright sun rays;
• a ban on visiting baths, saunas, swimming in hot water;
• a ban on any physical activity before obtaining permission from a doctor;
• replacement contact lenses glasses to prevent the risk of damage to eye tissues;
• repeated visit to the ophthalmologist at the appointed time.

If all stages of rehabilitation have been completed, the risk of complications is reduced.

Complications

During the operation or within a few days after it, the following complications may occur:

• hemorrhage in the cornea or inside the eyeball;
• rupture of muscle tissue, damage in this area;
• a sharp decrease in visual acuity up to complete blindness of the affected eye;
• entry bacterial infection in internal tissues, the risk of sepsis (infectious infection of the blood, which leads to the death of the patient without emergency medical assistance);
• inflammation of the eyelids, cornea, conjunctiva;
• no effect of operation further development strabismus.

Effective remedy to restore vision without surgery and doctors, recommended by our readers!

Strabismus, heterotropia, or strabismus is called a failure in binocular vision, when there is an incorrect coordination of the work of the eyes on the object in question. One or two eyes deviate from the center of the visual axis in the direction of the nose or temple, as a result of which the fixation of the eyes on the object is disturbed. If no correction methods help, surgery eliminates strabismus.

Definition of strabismus and methods of correction

Strabismus is considered to be a childhood disease, since it manifests itself precisely in childhood. The occurrence of strabismus in adults is much less common, the cause of which is often a disruption in the functioning of nerve connections. There are many reasons that contribute to the occurrence of strabismus:

• Traumatic brain injury;
• genetic predisposition;
• Psychological herbs;
• Poor circulation of the brain;
• Infectious diseases of the brain;
• Incorrect treatment of myopia and hyperopia;
• Excessive strain on the eyes;
• Violation of the extraocular muscles.

The strabismus test covers a holistic analysis of the organs of vision - the work and location of the muscles, the fundus and visual acuity, the angle of strabismus and the age of the patient are assessed. In the presence of strabismus, the operation is not immediately prescribed, it is first tried to be eliminated without surgical intervention. Treatment has three subsequent stages:

• Optical correction;
• Pleoptic treatment;
• Orthoptic treatment.

Optical correction is a treatment through properly selected glasses, lenses, in order to create optimal conditions for the functioning of the eyes. If there accompanying illnesses(nearsightedness, farsightedness, astigmatism, infections), then their treatment is carried out on this stage therapy.

Pleoptic treatment is aimed at increasing and equalizing the sharpness of both eyes to age norms.

Orthoptic treatment is essentially a preoperative step. It is advisable to carry it out only after relative equality has been created. visual acuity between the eyes. Its goal is to develop the patient's ability to turn on binocular vision (the ability to clearly see an object with both eyes) when looking away in different directions. In the absence of binocular vision, the question of a ban on the operation may arise. Symmetry of the eyes is possible only with the same spatial perception objects, objects with both eyes.

It is assigned only when the maximum possibility is reached. visual functions on both eyes.

Surgery for strabismus

All operations whose purpose is to correct strabismus are to correct the work of the oculomotor muscles - strengthening and weakening. Manipulations are carried out only within the framework of traditional surgery, laser correction strabismus is not practiced. Surgical treatment of strabismus consists in dissecting the muscle, and this cannot be done with a laser.

The goal of strabismus surgery is to restore muscle balance and binocular vision. But often it is possible to improve only cosmetic defects, the restoration of visual functions after surgery requires integrated approach and active conservative therapy. In ophthalmology, there are three areas of surgical correction of strabismus:

• Weakening traction of muscles;
• Strengthening traction;
• Changing the direction of muscle action.

Muscles that reduce cravings include:

• Recession, which implies surgical intervention, as a result of which a laxative effect of muscle traction is formed, achieved by shifting the place of attachment of the muscle to the beginning of the muscle.
• A myectomy is a procedure to remove a specific muscle from its insertion site. Basically, the indication for such an operation is muscle hypercontraction.
• Posterior fixation sutures - a procedure consisting in recession with successive suturing of the abdomen of the transposed muscle to the sclera, slightly behind the place of its attachment.

Aimed at restoring weakened oculomotor muscles:

• Resection is the process of excision of a certain area of ​​a weakened muscle at the site of its attachment, followed by its fixation. In fact, the remaining sections are stitched together.
• Tenorrhaphy is the process of shortening a muscle by creating a fold in the area of ​​the muscle tendon. As a result, the shortened muscle is significantly enhanced in terms of contractile function.
• Anteposition is the process of changing (transporting) the place of attachment of the muscle.

Advantages of surgical ophthalmology:

• Low trauma;
• The structure of the eye is preserved;
• The accuracy of the operation;
• Small % of consequences;
• High guarantee of a good result;
• A short recovery period.

Surgical intervention to eliminate strabismus does not give a 100% guarantee for a complete correction, but the chances are high - up to 80%. If strabismus persists after the manipulation, the operation can be repeated after six months. You should not expect that immediately after the operation you will see “correctly”. During the time that a person suffered from strabismus, the brain lost the habit, forgot how to compare visions from both eyes into one image, and it will take him a long time to learn this. As with any operation, there may be complications. First of all, these are calculation errors that lead to repeated strabismus.

The operation for strabismus takes place under complete or local anesthesia(according to indications) on an outpatient basis, a hospital is not required - a few hours after the operation, the patient is allowed to go home. Ophthalmic operations, like all others, are performed on an empty stomach. Everything is taken in advance necessary tests. During the procedure, the patient must be absolutely healthy (no ARVI, temperature, infections). The procedure on average does not exceed 30 minutes. After the operation, a special bandage is applied to the patient, which is left for 12-24 hours. Overlapping seams give sensation foreign object in the eye, they do not need to be removed, they dissolve within 6 weeks after application. After the operation, the patient needs the use of anti-inflammatory drops. With suppuration, washing will be indicated.

You need to do the following:

• Carefully protect the eye from contamination;
• Do not engage in physical labor for the first three weeks after surgery;
• Do not swim in public places;
• Do not disturb the eye, do not rub it.

After surgery, close monitoring of the eye is required. Regular visits to an ophthalmologist are required necessary drugs and eye rest. To restore muscles, a special system of exercises is being developed that must be performed. Assessment of the position of the eyes is checked no earlier than two months after surgery.

In secret

• Incredible… You can cure your eyes without surgery!
• This time.
• No trips to the doctors!
• This is two.
• In less than a month!
• It's three.

Follow the link and find out how our subscribers do it!

Strabismus- This pathological condition in which the eyeballs have different position in orbit and cannot carry out synchronous movements or, in other words, coherently “work as a team”. In people with this disease, one eye looks directly at the desired object, while the other may deviate inward or medially (convergent strabismus or esotropia), outward or laterally (exotropia - divergent strabismus), and also upward (hypertropia) or downward (hypotropia). ). Strabismus can be permanent or intermittent. Incorrect movements may affect one eye (unilateral strabismus) or both alternately (alternating strabismus).

To prevent double vision in congenital and early childhood strabismus, the brain begins to ignore visual information from an incorrectly directed eye, which leads to amblyopia, or the “lazy eye” effect. In mild cases in children, a conservative correction of the problem is possible through a set of individually designed visual exercises. But the most effective and radical method of treating strabismus is a surgical operation.

Indications for surgery

Traditionally, the goal of surgical treatment of strabismus is to restore the normal visual axis, eliminate diplopia, and restore or maintain normal binocular vision. Consider the indications for this surgical intervention in more detail:

1. Recovery of binocular vision. Experts now believe that early surgical intervention can help restore binocular vision in children.
2. Diplopia or double vision. This is especially true for older children and adults who first encountered deviation of the eyeballs. The degree of visual discomfort directly depends on the frequency of occurrence of deviations from the main axis. Moreover, significant deviations disturb patients less than small ones.
3. Paralytic strabismus. Surgical treatment is most effective for the treatment of severe paralytic strabismus with symptomatic diplopia. A well-planned operation helps to cope with paresis of the superior oblique muscles, which also restores binocular vision to patients.
4. Even rare deviations can lead to such an unpleasant condition as asthenopia. Clinical picture consists of difficulties with reading, headaches, weakness with prolonged eye strain.
5. Correction of cosmetic defects in children parents are often the most concerned. Several interventions may be needed to achieve this goal.

It must be understood that treatment choices and outcomes are highly dependent on the type of strabismus, the angle of deviation, and factors such as convergence deficiency or amblyopia. The essence of the operation is to influence the oculomotor muscles, the motor signals to which are sent by the brain, the methods of influence on which are currently unknown. That is why the deviation of the eyeballs can be observed after surgical correction. A series of interventions may be needed to achieve the desired goal.

Operation

During preoperative preparation a sensorimotor examination is performed by a specialist. It consists in external stimulation of the oculomotor muscles. Such a diagnostic procedure is necessary in order to determine which muscle structures make the main contribution to strabismus, which of them need to be affected (weakened, strengthened or moved). The degree of strabismus is also determined. Thus, the surgeon thoroughly studies the situation and determines the operation plan for himself. Often both eyes require intervention, although the deviation from the axis is present only on one side.

Surgery to correct strabismus is rarely associated with major bleeding. However, as a precaution, the doctor may recommend that you temporarily stop taking anticoagulants, antiplatelet agents, ibuprofen. Standard laboratory and instrumental examinations- general and biochemical analysis blood, fluorography or x-ray, electrocardiogram.

On the eve of the intervention, a decision is made on the method of anesthesia. Most often in children and adults, this is a general endotracheal anesthesia. In the presence of contraindications or unwillingness of the patient, retrobulbar injections are used as an alternative. local anesthetic in combination with intravenous sedation.

In the operating room, the patient is in the supine position. The skin of the periorbital region is carefully treated with an iodine-containing antiseptic. The surgeon and the operating nurse, after pre-treatment of the hands, put on sterile gowns and gloves. A sterile napkin with an opening for the operating field is placed on the face. All these measures are necessary for the prevention of infectious complications in postoperative period.

Principles of surgical intervention

In humans, there are 6 external oculomotor muscles that control the movement of the eyeballs within the orbit. Four of them are called direct (superior, inferior, medial and lateral). They attach to the corresponding pole of the eye and move it up, down, inward and outward, respectively. The two remaining muscle structures are responsible for complex movements and are called oblique. The work of all these muscles is coordinated by the neurons of the brain.

The purpose of surgical intervention is to influence the described muscle structures:

• Recession- an operation that weakens the rectus muscles of the eye, due to the transplantation of the muscle posterior to the place of its attachment.
• Resection or shortening of the muscle- an operation in which due to the shortening of the length of the muscle, it is strengthened.

The technique is as follows: for access, an incision is made on the conjunctiva. The muscles are located just under the conjunctival structures, which is why there is no need to cut the skin.

During recession the muscle is separated from its attachment to the eyeball. Then it moves backwards, after which it is fixed to the eye. Moving posteriorly from the anatomical attachment relaxes the muscle, allowing the eye to assume a level position.

Resection- This is a strengthening procedure, which is the excision of a part of the muscle fibers, followed by fixation of the muscle in an anatomical position. During preoperative preparation, the surgeon determines which specific extraocular muscles will be affected. The time required for such an intervention depends on many factors. As a rule, work with one muscle takes the surgeon about 20-30 minutes.

Today, the technique of adjustable seams is widely used. After resection or recession, muscles are fixed to the surface of the eyeball with special knots. At the end of the operation, the surgeon can easily access them. This is necessary in order to correct the position of the muscles in the postoperative period to achieve the best effect.

Postoperative period

The early postoperative period implies careful monitoring of the patient, control of his cardiorespiratory parameters. This is especially true after general anesthesia. The patient or his parents (such operations are often performed on children) receive detailed advice on postoperative care. Moderate soreness, hyperemia or itching in the area of ​​the operated eye is normal. The conjunctiva is usually hyperemic and edematous, and a permanent sensation of a foreign body is possible. An increase in volume due to swelling of the upper and lower eyelids is acceptable.

These symptoms resolve within 2-3 days. With severe pain, non-steroidal anti-inflammatory drugs (nimesulide, ketorolac) are acceptable in adults. Children are prescribed paracetamol or ibuprofen in the age dosage.

On the full recovery usually takes 1-2 weeks. After this time, adults can return to their daily activities, and children can go to school. It is important to take precautions - make sure that the eye does not come into contact with foreign bodies don't rub it dirty hands, and also to avoid all kinds of injuries to the organ.

Possible Complications

The likelihood of complications exists after any surgical operation This intervention is no exception. You may encounter the following unwanted scenarios:

1. Infectious complications, as a rule, take place in the early postoperative period, but meet infrequently. To prevent bacterial contamination, patients are prescribed eye drops with antibacterial drug. The first postoperative visit to the clinic is aimed at assessing the patient's condition and identifying similar complications. When a pronounced pain syndrome, swelling, redness, you should immediately consult your doctor.
2. Perforation of the sclera. During suturing of the extraocular muscles to the surface of the eye, there is a possibility of damage to the sclera by the needle. This usually ends with minor bleeding. In rare cases, with massive damage, retinal detachment is possible or cryotherapy is necessary. The use of modern needles avoids such situations.
3. Possible complications such as redness, itching, double vision (diplopia). These symptoms are usually transient and subside with recovery.
4. Moderate decreased visual acuity, sometimes requiring additional selection of glasses or contact lenses, is associated with a slight change in the shape of the eyeball after surgery.
5. Complete loss of vision is rare- 1 case per 10,000 operations. It is associated with endophthalmitis, retinal detachment, or massive hemophthalmos. Modern features ophthalmology allows you to notice the above formidable complications in time and take the necessary measures.

Sometimes patients mistakenly consider incomplete or insufficient correction of strabismus to be a complication. This is not entirely true. According to statistics, from 20 to 40% of such operations do not fully live up to expectations. As mentioned above, a series of interventions may be required to achieve the reference cosmetic effect.

Operation cost

Price for this operation depends on the reputation and equipment of the ophthalmological clinic, the qualifications of the specialist and the consumables used. There are also different categories of complexity of the operation. The cost of surgery to correct strabismus ranges from 25 to 40,000 rubles and is determined individually for each patient. Peri-operative diagnostic manipulations are paid separately.