Pediatric Surgery

Eye-Muscle Surgery

Eye-muscle surgery is often performed on children with strabismus (crossed or misaligned eyes) and other visual conditions.

Strabismus is sometimes called cross-eyed, walleye, or squint. Infants whose eyes are not aligned in the first two months of life should be closely monitored by their primary-care doctors, as strabismus does not always require surgery. Any child older than three months whose eyes are not properly aligned all of the time should be examined by a pediatric ophthalmologist.

Eye-muscle surgery is performed on an outpatient basis at the hospital, most often under general anesthesia.

The Surgical Procedure

Surgery to correct the eye's position is a common procedure. A small incision is made into the transparent covering of the eye (the conjunctiva) to reach the muscle. The muscle is then repositioned and reattached with tiny sutures that dissolve within one to two weeks. Most of our patients have surgery in the morning and then go home in the afternoon.

After Surgery

The healing process is gradual and lasts about six weeks. Antibiotic eye drops will be prescribed for five to seven days after surgery. Discomfort following eye-muscle surgery is usually minimal, but the eyes will be quite red and may display a jelly-like swelling. This is normal and will clear over the next few weeks. Please note that the redness sometimes spreads before clearing. Some children may experience temporary double vision after the surgery as the brain gets used to the new position of the eyes, again, this is normal and is no cause for alarm.

Treatment of Ptosis in Children

Thomas Eye Group provides greater Atlanta Ptosis treatment. Ptosis, or drooping of the upper eyelid, is a condition that may affect one or both eyes. It can be mild, where the lid partially covers the pupil, or severe where the lid completely covers the pupil. In children, ptosis is usually congenital. The most common reason is improper development of the levator muscle, the major muscle responsible for lifting the upper eyelid.

How Is Ptosis Treated?

Congenital ptosis is treated surgically, generally when the child is between three and five years of age. However, if the ptosis interferes with the child's vision, surgery may be performed earlier to allow for proper visual development.

A short incision is made in the natural skin crease and the eyelid raising muscle is shortened to lift the eyelid. Dissolving sutures are used inside the lid and on the skin.

After surgery, an eye pad is usually used for 24 to 48 hours and an ointment or antibiotic drops are prescribed for one to three weeks. The upper eyelid will usually appear swollen for the first 7 to 10 days.

What are the risks of Ptosis surgery?

  • Local bruising and swelling of the eyelids.
  • A small risk of wound infection to the eyelid.
  • Risk of over-correction (eyelid too high), or under-correction (eyelid still too low) which may require a second operation.
  • Inability to close the eyelids completely, which may be temporary or permanent. This requires lubricant drops and ointment. If it is permanent and threatens the vision, then the eyelid will have to be subsequently lowered again to protect the eye.
  • Sometimes if the other eye has a tendency to drop, this may become more noticeable after ptosis surgery on one side. Your pediatric specialist will warn you of this possibility.

Treatment of Cataracts in Children

The treatment of pediatric cataracts has advanced tremendously in recent years. Thomas Eye Group uses the latest technology at all of our locations during your child's pediatric cataract surgery.

Small pediatric cataracts that do not significantly reduce the vision may only require careful observation to ensure that the eye continues to develop well. Occasionally, glasses, contact lenses or eye patches are used to aid the affected eye's development.

Pediatric cataracts that significantly obstruct a child’s vision require surgery. Congenital cataract surgery may occur as early as a few months after birth.

How Is Surgery Performed?

Cataract surgery in children is performed under general anesthesia in the operating room. In some cases, a lens may be implanted inside the eye. This plastic lens implant is held in place by a natural membrane. Make sure to discuss the surgery in detail with your child's doctor.

After cataract surgery, treatment usually involves glasses, bifocals, contact lenses, and/or eye-patching therapy.

If you suspect your child might have cataracts, please call us for an appointment.

What to expect before surgery:

You will meet with your child's surgery scheduler who will have you complete paperwork including a history and physical and any additional health information. You will be given prescriptions for an antibiotic eye drop with instructions to begin taking the drop 3-4 days before your scheduled procedure.

You will receive a phone call from TESC’s pre-op nurse the day before your surgery. At this time, she will obtain your child's health information from you for our anesthesia department. Some of this may be seen a bit repetitive, but keep in mind TESC is committed to providing you with the safest, most effective ophthalmic care possible.

At this time, the nurse will give you some brief instructions including when to arrive for surgery, when and what your child may eat or drink, and what to bring for your procedure the next day.

Please be aware that the child's legal guardian must be present on the day of surgery to sign medical consent forms and remain in the waiting room for the duration of the procedure. **Please bring your insurance cards and a picture ID to your procedure the next day. Please leave all jewelry, extra money and personal items at home.**

What to expect the day of surgery:

You will arrive 1 hour before your child's scheduled surgery time. During the check-in process, you will be asked to present your insurance cards for verification. Your identity, as well as the identity of your child, will be verified. Matching bracelets will be placed on both yours and your child’s wrist to ensure patient safety. Once your check-in paperwork is complete, a pre-op nurse will call you when a bed is available for your child. Parents and guardians are welcome to accompany their child to the pre-op area and remain with them until it is time to take them to the operating room. We do ask that if it is not possible to leave siblings at home, that another adult wait with the sibling in the waiting room. We ask your cooperation with this policy to ensure the privacy of other patients, decrease the spread of cold and flu germs, and to maintain the safety and comfort of both patients and their siblings.

Once you and your child arrive in the pre-op area, the nurse will begin preparing your child for surgery. Preparation includes using the restroom/diaper changes and verifying your child’s surgical site and procedure, medical history and allergies. You will be asked to change your child into a gown. Your child’s operative eye will be marked for surgery either by the nurse or surgeon before they go back to the operating room.

In most cases, if an IV is required, it will be placed in the operating room after the child is "asleep". The Anesthesiologist will speak to you about what to expect regarding anesthesia before the procedure. This will give you an opportunity to ask any questions you may have. When it is time for your child’s procedure, the OR nurse will verify your child's name, surgical procedure scheduled, date of birth, and allergies.

The nurse and anesthesia personnel will take your child to the operating room and you can wait in one of our waiting rooms. Your child’s surgeon will speak with you after the surgery to update you on the procedure and answer any questions you may have.

What to expect after surgery:

After the procedure, your child will be returned to the recovery room and you will be able to sit with your child for the recovery process. When children wake up from surgery, they may seem distraught and disoriented. This is perfectly normal and will pass. Additional pain medication is available if your child’s anesthesiologist determines that it is needed.

When your child is awake, he/she will be offered clear liquids to drink. It is common after anesthesia for patients to experience nausea and/or vomiting. Your recovery room nurse will give you instructions on how to manage your child’s diet for the rest of the day. She will discuss the prescription eye drops that your child had started before surgery, as well as what you can expect for your child for the next few days. You will be given a written copy of any post-operative instructions. Once it has been determined that your child is stable, you may dress your child, the IV will be removed and you may take your child home.