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Adjustable Squint Surgery

What are the advantages of adjustable squint surgery? Videos of adjustable squint surgery on model eyes.

Video Transcript:

What are the advantages of adjustable squint surgery?

Adjustable squint surgery allows the surgeon to “fine tune” the position of the eyes, once the patient woken up from their anaesthetic. This technique is especially useful if the patient is at risk of developing double vision when their eyes are straightened. Almost all adult squint surgery is carried out with adjustable stitches. Adjustable squint surgery can also be used in children, although different surgeons will have different age limits for this form of surgery.

How is adjustable squint surgery performed?

Instead of reattaching the eye muscles to the outer coat of the eye with fixed knots, the surgeon ties a bow knot, similar to the way you would tie your shoe laces, or a slip-knot. The ends of the stitches are then tucked under the lining of the surface of the eye (known as the conjunctiva). Several hours after the operation the surgeon examines the position of the patient’s eyes and if the ocular alignment is satisfactory no adjustment of the muscles is needed. Some surgeons will leave the stitches to dissolve, others will trim the ends of the suture before discharging the patient. Adjustment can be carried out up to 48 hours after surgery.

However, if the eyes are not well aligned the eye is numbed with anaesthetic drops and the conjunctiva is gently moved to reveal the bow or slip knot. The bow knot is then untied or the slip knot adjusted and the muscle is either strengthened by pulling the muscle forward, or weakened by letting the muscle move backwards. After each adjustment the position of the eyes is rechecked. Once the eyes are correctly aligned a permanent knot is tied to secure the muscle in the appropriate position.

How do I know that I will be able to cope with an adjustable squint procedure?

In clinic there are a number of ways your surgeon can assess if you will be able to cope with adjustable squint surgery. Your surgeon can mimic some of the manoeuvres involved with the adjustment process by numbing your eye with anaesthetic drops and then holding the eye with some forceps and gently moving the eye from side to side. If you are able to tolerate this manoeuvre it is likely that you will cope with adjustable surgery. An alternative method is to see if you are able to tolerate a cotton bud touching the conjunctiva. Over the white part of the eye, without any numbing drops.

If you have undergone botox injections before your surgery, you will not have any difficulty coping with the adjustment process.