Strabismus surgery is a common procedure performed to correct eye misalignment in young children. Toddlers often undergo this surgery to improve binocular vision development and to support normal visual function during early childhood. Parents frequently have questions about how to prepare, how the surgery is performed, and what recovery will involve.
Purpose of Strabismus Surgery
Strabismus occurs when the eyes do not align properly. Toddlers may have eyes that turn inward, outward, upward, or downward. Because normal visual development depends on the brain receiving coordinated images from both eyes, early correction is important. When misalignment persists, the brain may suppress input from the deviated eye, which can lead to amblyopia.
Surgery aims to improve alignment by adjusting the eye muscles responsible for positioning the eye. While the goal is to create better alignment, some children may still require glasses, patching therapy, or additional treatments even after surgery.
Preparing for Surgery
Preoperative Evaluation
Parents can expect an evaluation with a pediatric ophthalmologist to determine whether surgery is appropriate. This evaluation includes an assessment of alignment, visual acuity, and overall eye health. Some children require preoperative treatment such as correction of refractive error or amblyopia therapy before proceeding with surgery.
Preoperative Instructions and Anesthesia
Once surgery is scheduled, families receive instructions regarding fasting before anesthesia, medication use, and arrival time on the day of the procedure. General anesthesia is used for toddlers to ensure safety and comfort, and parents typically remain with their child until shortly before the procedure begins.
The anesthesia team evaluates the child’s medical history to ensure that the child can safely undergo sedation. Parents should expect that their toddler may feel anxious before the procedure, and reassurance often helps ease this transition.
What Happens During the Procedure
Strabismus surgery involves adjusting the muscles that control eye movement. The surgeon works on the surface of the eye and does not enter the eyeball itself. The procedure usually involves tightening or loosening specific muscles to improve alignment, and in some cases more than one muscle requires adjustment. The duration of the procedure varies but commonly lasts less than an hour.
Toddlers remain fully asleep during surgery, and monitoring ensures that they stay safe throughout the procedure. After the adjustments are complete, the surgeon closes the tissue covering the muscles, often using dissolvable stitches, which eliminates the need for removal later.
Immediately After Surgery
Children are moved to the recovery area once anesthesia is discontinued. Toddlers often wake up feeling groggy, irritable, or disoriented; these reactions are normal and resolve as the effects of anesthesia wear off. The eyes may appear red, watery, or swollen, and parents may notice pink-tinged tears from mild postoperative bleeding during the first day.
Some toddlers may experience nausea after anesthesia. The care team monitors the child and provides medication if needed. Most children are ready to go home a few hours after the procedure once they are awake, drinking fluids, and stable.
What to Expect During the First Few Days
Redness and irritation are common during the initial recovery period. The surface of the eye may feel scratchy, and the toddler may rub their eyes if not closely monitored. Eye rubbing should be discouraged to prevent irritation or accidental injury, and some children benefit from wearing soft mittens during naps or bedtime to prevent rubbing.
The surgeon typically prescribes antibiotic or anti-inflammatory eye drops to reduce the risk of infection and support healing. Parents should expect to administer these drops for several days, following the dosage schedule provided. The child may be more tired than usual during the first twenty four hours, but most toddlers resume normal activity soon after.
Alignment may look improved immediately after surgery, but it can continue to change as the eyes heal. It is normal for the eyes to drift slightly during the first few weeks, and final alignment often stabilizes gradually.
Activity Restrictions and Care at Home
Most toddlers can return to gentle play quickly, but activities that risk eye injury should be avoided temporarily. These include roughhousing and contact sports, although toddlers rarely engage in high risk activities. Parents should avoid allowing their child to swim for at least one to two weeks because swimming increases the risk of infection. Bathing is safe as long as water is kept out of the eyes during the early healing period.
Parents should be prepared for visible redness lasting several weeks. This appearance does not indicate complications. The stitches dissolve naturally, and the conjunctiva heals over time without special care beyond medication and avoidance of eye rubbing.