Most patients, however, require surgical correction. Surgery is done under general anaesthesia in children and under local anaesthesia in adults.
The aim of the surgery is to tighten or loosen specific eye muscles required to realign the eyes. This is planned for both eyes simultaneously or on one at a time depending on the fitness for the procedure. Occasionally alignment is not achieved with the first surgery and additional surgery is needed.
The eye muscles are situated outside the eyeball and the procedure involves working on the white portion of the eyeball. The eyeball itself is not opened.
The principle of surgery is to weaken the stronger muscle and strengthen the weaker muscle. Either one or several muscles may be operated upon, depending on the type and severity of squint.
Eye is bandaged for one day after surgery.
After surgery, eye drops are prescribed and follow up visits advised.
The treatment does not stop with surgery. Glasses may have to be continued to maintain clarity of vision. Patching therapy may be needed to be continued for some time after the surgery.
With early detection, accurate diagnosis and proper treatment, the prognosis with strabismus is excellent. Treatment before age 8-9 years and especially by 6 years of age gives the best results.
Strabismus is a condition in which the eyes do not properly align with each other when looking at an object. The eye which is focused on an object can alternate. The condition may be present occasionally or constantly. If present during a large part of childhood, it may result in amblyopia or loss of depth perception. If onset is during adulthood, it is more likely to result in double vision.
Strabismus can occur due to muscle dysfunction, farsightedness, problems in the brain, trauma or infections. Risk factors include premature birth, cerebral palsyand a family history of the condition. Types include esotropia, where the eyes are crossed (“cross eyed”); exotropia, where the eyes diverge (“lazy eyed” or “wall eyed”); and hypertropia where they are vertically misaligned. They can also be classified by whether the problem is present in all directions a person looks (comitant) or varies by direction (incomitant). Diagnosis may be made by observing the light reflecting from the person’s eyes and finding that it is not centered on the pupil. Another condition that produces similar symptoms is a cranial nerve disease.
This is a very important question. When the eyes are too far apart, the brain has no way to bring the eyes together. The purpose of the strabismus surgery is to bring the eyes to a straighter position such that the brain has a better chance of adapting and moving the eyes closer to centre on its own.
The goal of strabismus surgery in iran is to reduce the amount of crossing and/or the frequency of crossing. The crossing, however, may still appear when you’re tired or ill but less often and less severely. This residual small amount of crossing (inward or outward) is expected and is sometimes technically referred to as a “monofixation” state. Studies have shown that a monofixation state leads to a lasting alignment over time. You will likely not even notice this small amount of crossing after surgery.
To summarize, the strabismus surgery can significantly improve your existing eye crossing but rarely, is it completely gone or “cured”. Therefore, the aim of strabismus surgery is to improve your existing condition enough so that your eyes seem essentially straight (or with a very small but acceptable deviation) most of the day, with the added benefits of improved appearance and functionality.
For individuals who have double vision, the goal of strabismus surgery here, is to alleviate the double vision in the straight ahead position and reading position (down gaze) or to expand the field of single vision. Some double vision in far side gaze or up-gaze may have to be tolerated after strabismus surgery , but these fields of gaze are generally less functionally important than straight ahead. Usually, most patients are not bothered by this, or compensate automatically with head movements.
In both children and adults, the surgery is usually performed under general anesthesia, although some adults can be done awake. Once asleep, an incision is made over the white part of the eye called the conjunctiva, which covers the muscle. The muscle of interest is separated from the eye and reattached with tiny sutures back to the eye but in a different position. One or more eye muscles may be operated on. Changing the position of the muscle mechanically changes its ability to pull by either strengthening or relaxing/weakening it. This new position of the eye muscle changes the angle of the eye but still allows the eye to move in all directions.
Note that the eyeball is not removed and there are no lasers used. The sutures dissolve on their own in about six weeks. You may have a patch after surgery, which must be kept in place until it is removed on the day of or the next day after surgery.
We may recommend for some individuals, either on the same day, or the next day after strabismus surgery , that the position of the eye muscle be further adjusted while the patient is awake. This is performed with topical anesthetic in a procedure room or in the clinic. This takes about 10 - 30 minutes. Understandably the patient may be anxious during the adjustment, but this is not a painful experience in general and most people discover it’s not as bad as they imagined.
Strabismus can be treated in various ways. Depending on the individual case, treatment options include : -
Glasses : - in some case prescribing glasses can enable the patient to realign their eyes
Prisms : - plastic prisms of the appropriate strength can be stuck on to the spectacle lenses to correct the misalignment of the eyes. These are particularly helpful in cases where the angle of the strabismus is small, if the strabismus is likely to resolve spontaneously (this is the case in many cases caused by circulatory problems) or if surgery is not possible. It may be possible to eventually incorporate this prismatic correction into the spectacle lenses themselves.
Botox injections : - Botulinum toxin is a drug, which if injected into a muscle causes it to become weakened for 3-4 months. It is frequently used in the management of patients with strabismus. Once the eye has been completed numbed with anaesthetic drops the Botox is injected directly into the appropriate eye muscle using a very fine needle. This procedure is carried out in the clinic. It is commonly used in the following situations;
to straighten the eyes when further surgery is not possible
to straighten poorly sighted eyes which are unlikely to stay in a straight position after strabismus surgery
to assess the risk of a patient developing double vision following strabismus surgery. By temporarily straightening the eyes with Botox Ophthalmologists can assess whether a patient is likely to develop troublesome double vision following surgery.
Surgery : - In many cases of strabismus, surgery is the only effective treatment. The aims of strabismus surgery are:
to eliminate double vision if present
to improve three-dimensional vision
to eliminate an abnormal head posture
improvement of psychosocial function
improvement of vocational status
Strabismus surgery is not a "cosmetic" procedure but should more appropriately be considered as reconstructive surgery. Cosmetic surgery (such as in face lifts, etc.) alters a normal appearance, whereas reconstructive surgery changes an abnormal appearance to one that is more normal.
The most serious risks of strabismus surgery are also the rarest.
Perforation of the outer coat of the eye (sclera) occurs in between 0.5 - 2.5% of operations. Very rarely this complication can result in an infection within the eyeball (endophthalmitis) or a retinal detachment, both of which could result in a permanent reduction in the vision of that eye.
A "lost muscle" can occur if a muscle is not tied securely to the outer coat of the eye. The muscle then recoils backwards behind the eyeball and can be very difficult if not impossible to find again. This complication is more likely to occur in redo operations.
Patients who have had a squint since childhood or have very poor vision in one eye usually have no 3-dimensional vision. This means they lack the ability to use their eyes together, even when the eyes have been straightened by strabismus surgery. In such patients there is a possibility that their eyes will drift inwards or outwards once again. It is not uncommon to have some temporary double vision for a short period after the surgery as the eyes adjust to their new position. The risk of developing troublesome double vision after surgery is reduced by the use of an adjustable stitch technique. It is important to remember that in the hands of an experienced strabismus surgeon surgery, the vast majority of operations are performed with no complications.
Approximately 4% of adults have misaligned eyes. Strabismus in adults can develop for many reasons;
The most common type of adult strabismus involves patients with misaligned eyes from childhood. This problem starts at a time when the patient can suppress (that is, 'turn off') one eye and thus avoid double vision. These patients may have undergone surgery to realign their eyes in childhood but the eyes have subsequently drifted inwards or outwards again.
Weakness of one or more eye muscles caused by damage to the nerves which stimulate the muscles. This usually results in the sudden onset of double vision caused by the eyes becoming misaligned. Circulatory problems are the most common cause of this type of strabismus, such as diabetes and high blood pressure. Inflammation of these nerves, head injuries (often caused by road traffic accidents or falls), or rarely direct pressure on the nerves by a tumour, can also cause this type of strabismus
Poor vision in one eye for whatever reason may eventually cause that eye to drift outwards or inwards.
Inflammation of the eye muscles can cause these muscles to become stiff and this may lead to strabismus and double vision. Thyroid eye disease is and example of such a condition
Adults who previous had well aligned eyes and who suddenly develop strabismus, will almost certainly suffer from double vision. The double vision may only be present when they look in a particular direction or it may occur irrespective of where they are looking. This double vision can be very trouble-some as it may interfere with everyday tasks and could disqualify the them from driving. In patients who are struggling to overcome strabismus and keep their eyes together, symptoms such as headaches, "eye strain" and intermittent double vision are common. These patients may have to tilt or turn their head in a certain direction to help control their strabismus. This compensatory head posture may cause neck and muscular problems.
Strabismus may be a sign of an underlying medical condition and any adult who suddenly develops strabismus should be seen by an Ophthalmologist who will be able to determine the cause of their strabismus.c
In addition to affecting eye function, misaligned eyes can get in the way of normal eye-to-eye contact, communication skills and social interaction. This can lead to reduced self-confidence and many patients will often look down or away from the person to whom they are speaking to avoid eye contact. The person being spoken to may be uncertain which eye the patient is using and may be distracted from what the patient is trying to communicate. Such impairment of communication skills can lead to limited job (or job advancement) opportunities.
Children should be monitored closely during infancy and the preschool years to detect potential eye problems, particularly if a relative has strabismus. Early detection, accurate diagnosis, and proper treatment can cure strabismus. It is recommended that all children be screened for eye health before age 6 months and again between 3 and 5 years of age by a pediatrician or an ophthalmologist.
Routine vision screening for young children includes testing for strabismus, usually using the light reflex for infants, and cover testing for preschool-age children.
Some squints are caused by refractive errors (spectacle powers), usually where one eye has a much higher power than the other. In such cases, squint can be corrected by prescribing proper spectacles.
In children, eye patch may be prescribed for the stronger eye to force the use of the weaker or suppressed eye. Eye drops are used to temporarily blur the vision of the preferred eye. Exercises may be prescribed to strengthen specific eye muscles.
In adult patients double vision caused by small squints can be corrected by incorporating prisms in the spectacles.
strabismus surgery cost depends upon the degree of squint in your eyes, your eyesight power and your eye sight case history.
strabismus surgery cost in iran start from $500.
The average strabismus surgery cost in the world is around $2000.
You do not need to worry about Strabismus surgery until you pay more attention to all these issues before proceeding. The important thing is to find a eye Surgeon . If you are looking for Strabismus surgery cost in Iran , you can contact us and Get free consultation from Iranian surgery.
Just like any other surgery, you should check your medical records with a professional doctor. To do this, you must send us all your medical files and medical IDs. We will connect you with the best doctors, hospitals and clinics in Iran, and then you can ask any questions you have in mind.
By traveling to Iran, you can save the most money and get the highest quality Strabismus surgery.
Low price is one of the most important features of Strabismus surgery in Iran. This is because the cost is less than 100 to 300 percent of the price of Amblyopia in Europe, Turkey, Qatar and the United States, while maintaining the same efficiency.
Most surgeons in Iran have high experience in Eye surgery.
Most Iranian surgeons graduate from reputable American and European universities and have enough experience to do so.
We offer the Strabismus surgery Package in iran at the most affordable prices Strabismus surgery Package in iran includes flight ticket, hotel, pick up, clinic and transfer.
Hotel / Transfer/ Full board / Visa
Items included in the package :
Clinic and doctor visits
Strabismus surgery in hospital
recovery and follow-up