Postoperative Expectations for Strabismus Surgery
Nausea: Quite common after eye muscle surgery. May last 24-48 hours.
Diet restrictions: Go easy on food the day of surgery. Start with sips of clear liquids, carbonated beverages, Popsicles, or ice chips. Later in the evening you may have soft foods such as ice cream, pudding, Jell-O, soup if tolerated. Appetite usually back to normal by the second day and you may resume your regular diet.
Pain/discomfort: Light sensitive for 1-2 days post-op. Eyes will feel scratchy for 1-2 days post-op. May have pain on rotating the eyes for approximately one week. Most stitches are buried and will dissolve on their own. Swelling next to conjunctiva and dry spots on the cornea may occasionally cause a scratchy sensation 3-5 days following surgery. Some may need Tylenol or Motrin for pain: occasionally something stronger but only in particular cases. If the eyes feel dry or scratchy it’s okay to use over the counter drops to lubricate the eyes, such as artificial tears.
Appearance of the Eyes: Red eyes for 10 days to two weeks. 90% of redness clears within two weeks. Some pinkness remains and gradually fades over several months. Children heal faster than adults. May have bloody discharge/matting of lashes, lasting approximately two days after surgery: the eyes may stick together in the morning: wipe eyes with a damp cloth.
Activities: You’ll be tired the day of surgery and will probably want to sleep the rest of the day. You’ll feel much better the second day after surgery. You/your child may resume normal activity if desired, usually after the second day, okay to return to school/work 1-2 days after surgery. Normal activity will not damage the eyes. Each person is different regarding recovery time. Some may want to take 1-2 weeks off following the surgery while others are ready to return to their regular schedule a few days after surgery. Driving is okay when you feel that it is safe to do so. It’s okay to fly anytime after surgery. Contact sports, swimming in a pool, eye make up, playing outside or in a sandbox are allowed 2-7 days after surgery. No swimming in a lake for 1 week.
Post Operative Medications/treatment: Continue with all medications the day after surgery. Oral antibiotics are given to both adults and children for the first 5 days following surgery. Start the day after surgery. TobraDex drops are sometimes given to adults four times a day for about 10 days after surgery. Ice or cold packs to the eyes the first few days post-op will often reduce any swelling that may be present. There will be no patches or bandages after surgery.
Postoperative Strabismus/diplopia: It takes approximately 6 weeks for the eyes to heal and gain their full function; therefore a lot of eye alignment changes take place during this time. Must allow a full 6 weeks before the outcome of the surgery can be accurately assessed. Adult double vision usually fades during the first 6 weeks post-op. Adults may patch one eye if too uncomfortable from the double vision, but we recommend that they try to tolerate it so that the brain may try to get used to the two eyes working together. Children may experience double vision if eyes cross inward after surgery; this usually clears in three weeks as the crossing goes away. Usually wait two weeks after surgery before resuming patching or Atropine for amblyopia.
Danger Signs: Increased swelling/pain of the conjunctiva and eyelids after the first 24-48 hours following the surgery may be serious and should be discussed with the doctor or nurse. Conjunctival swelling and a yellowish discoloration of the white part of the eye without pain may be just a reaction to blood absorbing. Adults with increased complaints of generalized pain (not just from looking in a particular direction) 2-3 days post op could be suffering from anterior segment ischemia (lack of blood to anterior segment). This is rare and should be seen by the doctor. SUDDEN changes in the eye alignment (overnight) may indicate a slipped muscle. This is also rare and should be seen by the doctor. The most critical time for infections and problems to occur is during the first week following the surgery.
Cataract Surgery Expectations
Cataract surgery takes about 45 minutes and is performed under general anesthesia. The white part of the eye will be very red with a watery discharge. For one day, a bandage is used and then a shield is used to protect the eye for several days. An antibiotic is given to prevent infection. A steroid treats inflammation and a dilating drop to dilate the pupil.
We may measure the curvature of the cornea for fitting contact lenses. If required, at the time of the surgery on the second eye, the first eye operated on may be examined to measure for the strength of a lens or to check the retina. The intraocular pressure may be measured. After surgery your child will be able to see shapes, such as a person, but no detail such as facial details.
There is usually internal irritation or inflammation after surgery. This can be associated with light sensitivity. ANY PAIN, SWELLING OF THE EYELIDS, A CLOUDY CORNEA OR FEVER SHOULD BE REPORTED TO YOUR DOCTOR. The eye bleeds very little. Sometimes there are a few drops of blood from the small vessels on the surface of the eye. Mild pain is present and can usually be managed with Tylenol.
Nasolacrimal Duct Probe and Irrigation and Stent Placement
These procedures, when done under general anesthesia, follow the same guidelines for preparing your child for surgery and fasting (see above).
After surgery, tearing with discharge or bloody tears is common and usually resolves after a day or so. Tylenol may be given for pain. No bandages are required. You may be asked to instill eye drops following surgery. Oral antibiotics are typically not required.