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Recessing a horizontal rectus muscle This is the most commonly- performed strabismus operation in my practice. The muscle is re-positioned on the surface of the eye to change the mechanics of eye movement, usually positioning the globe outward to adjust for a "crossed" eye (esotropia). This may be done to one or both eyes depending on the underlying problem and the size of the eye deviation. After placing sterile cloth drapes and protective plastic to isolate the operative field, a small lid speculum is positioned to separate the eyelids (photo 1 at left). A thin "lining" layer of tissue called the conjunctiva is carefully separated from the underlying white sclera. Small blood vessels are cauterized to keep the operative field cleanly visible. The muscle is usually attached to the eye between 4 and 7 mm from the junction of the sclera and clear cornea (an anatomical landmark called the "limbus"). A small muscle hook is carefully positioned under the muscle insertion and additional dissection separates the muscle from surrounding tissues (photo 2). Small thread-like sutures are placed in muscle tissue just behind the insertion and the muscle is cut free from the eye. The new muscle position is marked on the sclera, and the muscle is re-attached to the eye using the pre-placed sutures (arrow, photo 3). The lining conjunctiva is closed using very tiny sutures (photo 4). The lid speculum is removed and a small amount of an topical antibiotic/steroid ointment is placed on the operated area. All surgical drapes are removed and the operative field is cleaned. The patient is slowly awakened from anesthesia prior to transfer to the recovery area. The operative field will be slightly red at the conclusion of the operation, and this commonly increases during the first 24 to 48 hours following the case. Patients experience varying degrees of discomfort initially and may have difficulty opening the eye until later in the day or even the next day following surgery. I generally do not patch the eye closed, having observed over the years that post-op swelling usually regresses more quickly if the eye is not covered. I will give you the antibiotic/steroid ointment but generally tell you that its use is optional. The eye usually heals quite nicely following strabismus surgery with no applied medication. In some cases I think that trying to force the ointment into the eye of a struggling young child can have more risk of loosening or tearing tiny stitches than the medication helps with the healing process. |
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