Strabismus Correction Surgery (Eye Muscle Surgery)

The attachment points or effective lengths of one or more extraocular muscles are surgically adjusted to rebalance the forces on the globe, aligning the eyes in all positions of gaze to restore binocular visual function and improve appearance.

Strabismus correction surgery repositions the attachments or alters the lengths of the six extraocular muscles (medial and lateral rectus, superior and inferior rectus, superior and inferior oblique) to balance their respective pulling forces on the globe, achieving ocular alignment that restores binocular vision, eliminates diplopia, and improves cosmesis. The principal surgical techniques are: weakening procedures (recession — the muscle insertion is detached and reattached posterior to the original site, reducing its mechanical advantage) and strengthening procedures (resection — a segment of muscle is excised to shorten and increase its force; or advancement — moving the insertion anteriorly). Horizontal strabismus (esotropia, exotropia) is addressed with medial and lateral rectus recessions and resections; vertical and torsional strabismus requires vertical rectus or oblique muscle surgery. Surgery is performed under local anesthesia with or without sedation in cooperative adults, and under general anesthesia in children and uncooperative patients. Adjustable suture technique is a major advance for adult strabismus — sutures are tied in a bow-tie slip-knot and adjusted postoperatively once the patient is alert and cooperative (typically 4-6 hours after surgery), allowing fine-tuning of the final eye position and significantly improving surgical accuracy, particularly for paralytic strabismus or residual deviation. For children, early surgery during the visual developmental sensitive period (generally before age 8) is important for establishing normal binocular vision. In adults, the primary goals are diplopia elimination and cosmetic improvement; restoration of full binocular stereopsis is more limited.