Strabismus Surgery in Bluffton & Hilton Head Island

Strabismus is misalignment of the eyes — one eye turning in, out, up or down, either all the time or only some of the time. Surgery on the eye muscles is one of the main ways it is corrected, in children and in adults.

At Goulas Eye, strabismus surgery is performed by Dr. Erin Benjamin, who completed a fellowship in pediatric ophthalmology and adult strabismus at Akron Children's Hospital. That is a year of subspecialty training beyond becoming an ophthalmologist, devoted to exactly this — and it is not widely available in this part of South Carolina.

How the surgery works

Each eye is moved by six small muscles attached to the outside of the eyeball. When the pull between them is out of balance, the eyes do not point in the same direction.

Strabismus surgery adjusts those muscles to rebalance that pull. Depending on the type of misalignment, a muscle may be loosened, tightened, or moved to a slightly different position where it attaches to the eye. Surgery can involve one eye or both, and one muscle or several.

A common worry is worth answering plainly: the eye is not removed from its socket. The muscles are reached through the clear membrane covering the white of the eye, and the incisions are typically not visible afterwards.

Is surgery always needed?

No — and for many children it is not the first treatment.

Some kinds of strabismus, particularly an inward turn linked to farsightedness, are corrected completely by glasses. When a misaligned eye has also led to reduced vision, patching or drops to strengthen the weaker eye usually come first. Surgery is considered when alignment is not corrected by those measures, or when the type of strabismus is one that glasses cannot address.

The right answer depends on the cause, the type of misalignment and the patient's age, which is what the consultation is for. See pediatric eye care for how children's eye problems are assessed.

Strabismus surgery for adults

This deserves its own section, because adults are routinely told — or simply assume — that nothing can be done.

Adults develop strabismus for many reasons: a childhood condition that held for decades and then decompensated, thyroid eye disease, a stroke, a cranial nerve palsy, an injury, or occasionally as a complication of other eye surgery. The result is often double vision, which is disruptive in a way that is hard to overstate, and people frequently adopt a head tilt or turn without realising it to compensate.

Adult strabismus surgery is not merely cosmetic. It can restore alignment, eliminate or reduce double vision, relieve compensatory head postures, and expand the field of vision. It is also not "too late" in the way many adults have been led to believe.

For some adults, prisms built into glasses are an alternative or an interim step, and they are worth discussing before deciding on surgery.

What to expect

Strabismus surgery is performed as an outpatient procedure — you or your child go home the same day.

Children have surgery under general anesthesia. Many adults do too, though the approach for adults is discussed individually.

Afterwards, expect the eye to look red for a week or two, and to feel scratchy or sore for a few days. Most people are back to ordinary activities within a few days. Eye drops are usually prescribed for a short period, and there will be follow-up visits to check healing and alignment.

Results, honestly

Most patients see a meaningful improvement in alignment. It is worth knowing in advance that strabismus surgery is not always a single operation: because the muscles and the brain's control of them vary from person to person, some patients need a further procedure to fine-tune the result. That is a normal part of the treatment, not a sign that something went wrong.

In children, surgery on the alignment does not by itself restore vision in a weaker eye. If amblyopia is present, treatment for that continues alongside.

Risks

Strabismus surgery is well established and serious complications are uncommon. As with any surgery, there are risks — including over- or under-correction, infection, bleeding, and in rare cases changes to vision. These are discussed specifically at the consultation rather than in general terms.

If you or your child have noticed an eye turning, or you are living with double vision, start with a comprehensive eye exam. Finding the cause comes first.