Strabismus (Squint) Surgery for Children and Adults in Antalya

An eye that turns in, out, up or down changes how a child learns to see, and how an adult sees and is seen. Many people put off treatment because they fear the eye will be taken out or cut open. It is not: strabismus surgery works on the muscles on the outside of the eye.

This page explains when glasses, patching or other treatments come first, how the operation is done, and what results, risks and recovery to expect.

What is strabismus?

Strabismus (squint) means that the two eyes do not point at the same thing. One eye looks straight ahead while the other turns in, out, up or down. The turn may be there all the time or only now and then, for example when a child is tired.

Worldwide, about 2 in 100 people have an eye that turns in or out. Strabismus usually starts in childhood, but it can also begin in adult life: about 4 in 100 people develop it at some point as adults.

When does a child need strabismus surgery?

Every child with a squint needs a full eye examination with dilated pupils. Many squints are linked to long sight or to a lazy eye (amblyopia), and some are treated without any operation. Rarely, a squint is the first sign of an eye disease such as retinoblastoma, a cancer of the retina in young children.

Treatment usually starts with the basics:

• Glasses. In accommodative esotropia, the eye turns in because the child is long-sighted. Glasses alone control the turn in about 2 of 3 of these children.
• Treating a lazy eye first. Patching the better eye, or drops that blur it, make the weaker eye work. This usually comes before surgery and can improve the result.
• Watching. A mild outward turn that the child controls well is often watched or treated with part-time patching.

Surgery is considered when the eye still turns despite glasses and patching, or when the turn is large and constant. In infantile esotropia, a large inward turn that starts before 6 months of age, surgery is usually done before the age of 2. In a European study, children whose eyes were aligned at about 20 months developed some 3D vision more often than children aligned at about 4 years (13.5% vs 3.9%).

Surgery straightens the eyes, but it does not replace glasses or treatment for a lazy eye. Many children still need both afterward.

Can strabismus be corrected in adults?

Yes. There is no upper age limit: people in their 90s have benefited from surgery, and a squint present since childhood can still be corrected. In adults, the operation can:

• remove or reduce double vision;
• correct a head turn or tilt used to avoid double vision;
• widen the area in which both eyes work together;
• restore a normal appearance and eye contact.

The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) calls this reconstructive surgery, not cosmetic surgery, because it restores a normal function. Adults who have been treated report better self-esteem and less anxiety in social situations.

Before surgery, your doctor checks whether straighter eyes could cause double vision. A simple test with prisms simulates the planned result. If the squint was caused by a nerve palsy, thyroid eye disease or a fracture, surgery waits until the measurements have been stable, usually for at least 6 months.

What can be tried before surgery?

How is strabismus surgery done?

The muscles that move the eye are attached to its white outer wall, the sclera. The surgeon reaches them through a small opening in the conjunctiva, the thin clear membrane over the white of the eye. There is no cut in the skin, and the eye stays in its place.

A muscle can be made to pull less or more:

• Weakening (recession): the muscle is detached and stitched back onto the eye wall a few millimeters further back.
• Strengthening (resection or plication): the muscle is shortened, or folded, so that it pulls harder.
• Transposition: when a muscle is paralyzed, parts of the neighboring muscles are moved to take over some of its pull.

Depending on the type of squint, the operation is done on one eye or on both, even when only one eye seems to turn.

1. Measurements. The turn is measured with prisms, for distance and near and in different directions of gaze. The operation is planned from these numbers.
2. Anesthesia. Children have general anesthesia. Adults have general anesthesia or local anesthesia with sedation.
3. The operation. It takes about 40 minutes to 2 hours, depending on how many muscles are adjusted. The stitches usually dissolve.
4. Home the same day. Strabismus surgery is usually a day procedure.

What are adjustable stitches?

Some adults and older teenagers have adjustable stitches. The muscle is tied with a temporary knot. A few hours later, or within the first week, the position of the eyes is checked while you are awake. The knot is then tightened or loosened under numbing drops. In a large US registry of adults, fewer people with adjustable stitches needed another operation within a year (6.0% vs 8.1%). Young children usually do not have them, because the adjustment needs their cooperation.

What results can you expect?

Success is usually defined as a small remaining turn, not perfectly straight eyes. The final position settles over about 6–8 weeks, sometimes up to 3 months. In some types of adult strabismus, double vision when looking straight ahead goes away in more than 95%.

Some eyes drift again over the years, especially an eye that turned out. In a large US registry, most people needed only one operation:

In children with infantile esotropia, 15–30% need more than one operation. That is why children have regular check-ups for years after surgery.

What are the risks?

Strabismus surgery is a common operation, and serious complications are rare. The table lists the main risks, from the most common to the rarest.

In a UK study of about 24,000 operations, a severe complication occurred in about 1 in 400. A poor final result, meaning loss of vision or double vision when looking straight ahead, occurred in about 1 in 2,400. Loss of vision is very rare, about 1 in 30,000.

What is recovery like, and when can you fly home?

Avoid swimming for 2–6 weeks, as your surgeon advises. Do not drive for 48 hours after general anesthesia, or for as long as you see double.

Flying is restricted after some eye operations because of a gas bubble placed inside the eye. Strabismus surgery is done on the outside of the eye, and no gas is used, so the eye itself does not stop you from flying. It is still wise to fly home only after the first check-up, about a week after surgery. Your surgeon confirms the date.

What about thyroid eye disease and eye injuries?

In thyroid eye disease, the eye muscles swell and stiffen and pull the eye out of line. The muscle below the eye is affected most often. Muscle surgery is planned only when the disease has been inactive and the measurements have been stable for at least 6 months. If the orbit also needs orbital decompression, that comes first, then eye-muscle surgery, and eyelid surgery last. In published results for thyroid eye disease, about 7 in 10 had good alignment after surgery, and about 6 in 10 were free of double vision.

After a fracture of the eye socket, double vision often improves as the swelling settles. Muscle surgery for double vision that remains is usually planned 6–9 months after the injury. See also war-related eye injuries.

Strabismus surgery in Antalya

Prof. Dr. Elif Betül Türkoğlu performs strabismus surgery for children and adults in Antalya, Türkiye. She is a professor of ophthalmology whose work also covers eye tumors, cataract surgery and oculoplastic surgery. At the consultation, she examines both eyes, measures the squint and explains the options.

If you live abroad, you can first send earlier reports, your glasses prescription and photos of the eyes looking straight ahead and to each side. Plan to stay in Antalya until the first check-up, about a week after surgery. Consultations are in English or Turkish. If needed, BergemHealth, the practice's international patient coordination partner, provides an interpreter and a personal escort who speak Ukrainian and Russian. See international patients.