Skip to main content

Strabismus Surgery

  • Chapter
  • First Online:
Strabismus

Abstract

We usually straighten eyes by shortening (recessing) muscles, which is thought to weaken them, or stretching (resecting, plicating, tucking, etc.) muscles, which is thought to tighten or strengthen them. When muscles are recessed, there are two different effects. An acutely shortened muscle should be weaker because of Starling’s law on muscle contraction, which states that the more a muscle is stretched, the greater its force of contraction.

Surgeons must be very careful

When they take the knife.

Underneath their fine incisions

Stirs the culprit,—life!

—Emily Dickinson

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

References

  1. Kushner BJ. Multiple mechanisms of extraocular muscle “overaction”. Arch Ophthalmol. 2006;124:680–8.

    Article  PubMed  Google Scholar 

  2. Scott AB. Change of eye muscle sarcomeres according to eye position. J Pediatr Ophthalmol Strabismus. 1994;31:85–8.

    CAS  PubMed  Google Scholar 

  3. Apt L, Call NB. An anatomical reevaluation of rectus muscle insertions. Ophthalmic Surg. 1982;13:108–12.

    CAS  PubMed  Google Scholar 

  4. Helveston EM, Ellis FD, Schott J, et al. Surgical treatment of congenital esotropia. Am J Ophthalmol. 1983;96:218–28.

    Article  CAS  PubMed  Google Scholar 

  5. Kushner B, Lucchese N, GV M. Should recessions of the medial recti be graded from the limbus or insertion. Arch Ophthalmol. 1989;107:1755–8.

    Article  CAS  PubMed  Google Scholar 

  6. Kushner B, Preslan M, Vrabec M. Artifacts of measuring during strabismus surgery. J Pediatr Ophthalmol Strabismus. 1987;24:159–64.

    CAS  PubMed  Google Scholar 

  7. Bloom JN, Parks MM. The etiology, treatment and prevention of the “slipped muscle”. J Pediatr Ophthalmol Strabismus. 1981;18:6–11.

    CAS  PubMed  Google Scholar 

  8. Ludwig IH, Chow AY. Scar remodeling after strabismus surgery. J AAPOS. 2000;4:326–33.

    Article  CAS  PubMed  Google Scholar 

  9. Jung JH, Leske DA, Holmes JM. Classifying medial rectus muscle attachment in consecutive exotropia. J AAPOS. 2016;20:197–200.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kushner BJ. Evaluation of the posterior fixation plus recession operation with saccadic velocities. J Pediatr Ophthalmol Strabismus. 1983;20:202–9.

    CAS  PubMed  Google Scholar 

  11. Scott AB. The faden operation: mechanical effects. Am Orthopt J. 1977;27:44–7.

    Article  CAS  PubMed  Google Scholar 

  12. Millicent M, Peterseim W, Buckley EG. Medial rectus faden operation for esotropia only at near fixation. J AAPOS. 1997;1:129–33.

    Article  CAS  PubMed  Google Scholar 

  13. Kushner BJ, Preslan MW, Morton GV. Treatment of partly accommodative esotropia with a high accommodative convergence-accommodation ratio. Arch Ophthalmol. 1987;105:815–8.

    Article  CAS  PubMed  Google Scholar 

  14. Scott A. Posterior fixation: adjustable and without posterior sutures. In: Lennerstrand G, editor. Clinical strabismus management. Boca Raton: WB Saunders; 1994. p. 399.

    Google Scholar 

  15. Bock CJ Jr, Buckley EG, Freedman SF. Combined resection and recession of a single rectus muscle for the treatment of incomitant strabismus. J AAPOS. 1999;3:263–8.

    Article  PubMed  Google Scholar 

  16. Thacker NM, Velez FG, Rosenbaum AL. Combined adjustable rectus muscle resection--recession for incomitant strabismus. J AAPOS. 2005;9:137–40.

    Article  PubMed  Google Scholar 

  17. Christiansen SP, Antunes-Foschini RS, McLoon LK. Effects of recession versus tenotomy surgery without recession in adult rabbit extraocular muscle. Invest Ophthalmol Vis Sci. 2010;51:5646–56.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Apt L, Isenberg S. Eye position of strabismic patients under general anesthesia. Am J Ophthalmol. 1977;84:574–9.

    Article  CAS  PubMed  Google Scholar 

  19. Lingua RW, Azen SP, Walonker F, Levin L, Baker S. A comparison of the succinylcholine induced ocular position and the postoperative alignment in strabismus. J Pediatr Ophthalmol Strabismus. 1986;23:69–73.

    CAS  PubMed  Google Scholar 

  20. Lingua RW, Levin L, Azen SP, Baker S, Walonker F. Comparison of the succinylcholine induced ocular position and the postoperative alignment in strabismus. J Ophthalmic Nurs Technol. 1987;6:7–13.

    CAS  PubMed  Google Scholar 

  21. Romano P, Gabriel L, Bennett W, Snyder B. Stage I intraoperative adjustment of eye muscle surgery under general anesthesia: consideration of graduated adjustment. Graefes Arch Ophthalmol. 1988;226:235–40.

    Article  CAS  Google Scholar 

  22. Romano PE. Stage III intraoperative adjustment of eye muscle surgery (under general anesthesia) for neuroparalytic and mechanical (restrictive) incomitant strabismus: Report of results in a series: outcomes in 20 eye muscle surgeries in twelve patients. Binocul Vis Strabolog Q Simms Romano. 2012;27:46–50.

    PubMed  Google Scholar 

  23. Jampolsky A. Spring-back balance test in strabismus. Transactions of the New Orleans Academy of Opththalmology. St Louis: Mosby; 1978. p. 104–11.

    Google Scholar 

  24. Guyton DL. Exaggerated traction test for the oblique muscles. Ophthalmology. 1981;88:1035–40.

    Article  CAS  PubMed  Google Scholar 

  25. Kushner BJ. Superior oblique tendon incarceration syndrome. Arch Ophthalmol. 2007;125:1070–6.

    Article  PubMed  Google Scholar 

  26. McKeown C, Lambert H, Shore J. Preservation of the anterior ciliary vessels during extraocular muscle surgery. Ophthalmology. 1989;96:498–506.

    Article  CAS  PubMed  Google Scholar 

  27. Repka MX, Fishman PJ, Guyton DL. The site of reattachment of the extraocular muscle following hang-back recession. J Pediatr Ophthalmol Strabismus. 1990;27:286–90.

    CAS  PubMed  Google Scholar 

  28. Spielmann A. Association of fixed suspensions of the capsulo-palpebral head of the inferior rectus with semi-adjustable recession of the inferior rectus muscle to minimize complications. In: Kaufmann H, editor. Transactions of the 21st meeting of the European Strabismological Association. Giessen: Gahmig Druck; 1993. p. 175–80.

    Google Scholar 

  29. Kushner BJ. An evaluation of the semiadjustable suture strabismus surgical procedure. J AAPOS. 2004;8:481–7.

    Article  PubMed  Google Scholar 

  30. Foster RS. Vertical muscle transposition augmented with lateral fixation. J AAPOS. 1997;1:20–30.

    Article  CAS  PubMed  Google Scholar 

  31. Iizuka M, Kushner B. Surgical implications of the superior oblique frenulum. J AAPOS. 2008;12:27–32.

    Article  PubMed  Google Scholar 

  32. Knapp P. The surgical treatment of double-elevator palsy. Trans Am Ophthalmol Soc. 1969;67:304–23.

    CAS  PubMed  PubMed Central  Google Scholar 

  33. Mehendale RA, Dagi LR, Wu C, Ledoux D, Johnston S, Hunter DG. Superior rectus transposition and medial rectus recession for Duane syndrome and sixth nerve palsy. Arch Ophthalmol. 2012;130:195–201.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Yang S, MacKinnon S, Dagi LR, Hunter DG. Superior rectus transposition vs medial rectus recession for treatment of esotropic Duane syndrome. JAMA Ophthalmol. 2014;132:669–75.

    Article  PubMed  Google Scholar 

  35. Velez FG, Oltra E, Isenberg SJ, Pineles SL. Assessment of torsion after superior rectus transposition with or without medial rectus recession for Duane syndrome and abducens nerve palsy. J AAPOS. 2014;18:457–60.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Oltra EZ, Pineles SL, Demer JL, Quan AV, Velez FG. The effect of rectus muscle recession, resection and plication on anterior segment circulation in humans. Br J Ophthalmol. 2015;99:556–60.

    Article  PubMed  Google Scholar 

  37. Velez FG, Demer JL, Pihlblad MS, Pineles SL. Rectus muscle plication using an adjustable suture technique. J AAPOS. 2013;17:480–3.

    Article  PubMed  Google Scholar 

  38. Leenheer RS, Wright KW. Mini-plication to treat small-angle strabismus: a minimally invasive procedure. J AAPOS. 2012;16:327–30.

    Article  PubMed  Google Scholar 

  39. Clark RA, Isenberg SJ, Rosenbaum AL, Demer JL. Posterior fixation sutures: a revised mechanical explanation for the faden operation based on rectus extraocular muscle pulleys. Am J Ophthalmol. 1999;128:702–14.

    Article  CAS  PubMed  Google Scholar 

  40. Clark RA, Ariyasu R, Demer JL. Medial rectus pulley posterior fixation: a novel technique to augment recession. J AAPOS. 2004;8:451–6.

    Article  PubMed  Google Scholar 

  41. Velez FG, Thacker N, Britt MT, Alcorn D, Foster RS, Rosenbaum AL. Rectus muscle orbital wall fixation: a reversible profound weakening procedure. J AAPOS. 2004;8:473–80.

    Article  PubMed  Google Scholar 

  42. Ela-Dalman N, Velez FG, Felius J, Stager DR Sr, Rosenbaum AL. Inferior oblique muscle fixation to the orbital wall: a profound weakening procedure. J AAPOS. 2007;11:17–22.

    Article  PubMed  Google Scholar 

  43. Goldberg RA, Rosenbaum AL, Tong JT. Use of apically based periosteal flaps as globe tethers in severe paretic strabismus. Arch Ophthalmol. 2000;118:431–7.

    Article  CAS  PubMed  Google Scholar 

  44. Underdahl JP, Demer JL, Goldberg RL, Rosenbaum AL. Orbital wall approach with preoperative orbital imaging for identification and retrieval of lost or transected extraocular muscles. J AAPOS. 2001;5:230–7.

    Article  CAS  PubMed  Google Scholar 

  45. Kushner BJ. Torsion and pattern strabismus: potential conflicts in treatment. JAMA Ophthalmol. 2013;131:190–3.

    Article  PubMed  Google Scholar 

  46. von Noorden GK, Jenkins RH, Chu MW. Horizontal transposition of the vertical rectus muscles for cyclotropia. Am J Ophthalmol. 1996;122:325–30.

    Article  Google Scholar 

  47. Scott AB. Graded rectus muscle tenotomy for small deviations. In: Proceedings of the Jampolsky festschrift. San Francisco: The Smith-Kettlewell Eye Research Institute; 2000. p. 215–6.

    Google Scholar 

  48. Scott A. Graded rectus muscle tenotomy. Arch Chil Oftal. 2006;63:127–8.

    Google Scholar 

  49. Wright KW. Mini-tenotomy procedure to correct diplopia associated with small-angle strabismus. Trans Am Ophthalmol Soc. 2009;107:97–102.

    PubMed  PubMed Central  Google Scholar 

  50. Chaudhuri Z, Demer JL. Sagging eye syndrome: connective tissue involution as a cause of horizontal and vertical strabismus in older patients. JAMA Ophthalmol. 2013;131:619–25.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Tan RJ, Demer JL. Heavy eye syndrome versus sagging eye syndrome in high myopia. J AAPOS. 2015;19:500–6.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Pineles SL. Divergence insufficiency esotropia: surgical treatment. Am Orthopt J. 2015;65:35–9.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Kushner BJ. Vertical strabismus. In: Lambert SR, Lyons CJ, editors. Taylor & Hoyt’s pediatric ophthalmology and strabismus. 5th ed. London: Elsevier; 2017. p. 27–37.

    Chapter  Google Scholar 

  54. Clark RA. The role of extraocular muscle pulleys in incomitant non-paralytic strabismus. Middle East Afr J Ophthalmol. 2015;22:279–85.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Krzizoh TH, Kaufmann H, Traupe H. Elucidation of restrictive motility in high myopia by magnetic resonance imaging. Arch Ophthalmol. 1997;115:1019–27.

    Article  CAS  PubMed  Google Scholar 

  56. Yamaguchi M, Yokoyama T, Shiraki K. Surgical procedure for correcting globe dislocation in highly myopic strabismus. Am J Ophthalmol. 2010;149:341–6.

    Article  PubMed  Google Scholar 

  57. Scott AB. Botulinum toxin injection into extraocular muscles as an alternative to strabismus surgery. J Pediatr Ophthalmol Strabismus. 1980;17:21–5.

    CAS  PubMed  Google Scholar 

  58. Scott AB. Botulinum toxin injection of eye muscles to correct strabismus. Trans Am Ophthalmol Soc. 1981;79:734–70.

    Google Scholar 

  59. Scott AB. Botulinum treatment of strabismus following retinal detachment surgery. Arch Ophthalmol. 1990;108:509–10.

    Article  CAS  PubMed  Google Scholar 

  60. Scott AB, Magoon EH, McNeer KW, Stager DR. Botulinum treatment of childhood strabismus. Ophthalmology. 1990;97:1434–8.

    Article  CAS  PubMed  Google Scholar 

  61. Scott AB. Development of botulinum toxin therapy. Dermatol Clin. 2004;22:131–3, v

    Article  PubMed  Google Scholar 

  62. Scott AB, Kraft SP. Botulinum toxin injection in the management of lateral rectus paresis. Ophthalmology. 1985;92:676–83.

    Article  CAS  PubMed  Google Scholar 

  63. Scott AB, Magoon EH, McNeer KW, Stager DR. Botulinum treatment of strabismus in children. Trans Am Ophthalmol Soc. 1989;87:174–80; discussion 80–4

    CAS  PubMed  PubMed Central  Google Scholar 

  64. Scott AB, Miller JM, Shieh KR. Treating strabismus by injecting the agonist muscle with bupivacaine and the antagonist with botulinum toxin. Trans Am Ophthalmol Soc. 2009;107:104–9.

    PubMed  PubMed Central  Google Scholar 

  65. Phillips PH, Guyton DL, Hunter DG. Superior oblique overaction from local anesthesia for cataract surgery. J AAPOS. 2001;5:329–32.

    Article  CAS  PubMed  Google Scholar 

  66. Kushner BJ, Vrabec M. Theoretical effects of surgery on length tension relationships in extraocular muscles. J Pediatr Ophthalmol Strabismus. 1987;24:126–31.

    CAS  PubMed  Google Scholar 

  67. Kushner BJ, Morton GV. Postoperative binocularity in adults with longstanding strabismus. Ophthalmology. 1992;99:316–9.

    Article  CAS  PubMed  Google Scholar 

  68. Kushner BJ. Binocular field expansion in adults after surgery for esotropia. Arch Ophthalmol. 1994;112:639–43.

    Article  CAS  PubMed  Google Scholar 

  69. Johnson CA, Keltner JL. Incidence of visual field loss in 20,000 eyes and its relationship to driving performance. Arch Ophthalmol. 1983;101:371–5.

    Article  CAS  PubMed  Google Scholar 

  70. Keltner JL, Johnson CA. Visual function, driving safety, and the elderly. Ophthalmology. 1987;94:1180–8.

    Article  CAS  PubMed  Google Scholar 

  71. Keltner JL, Johnson CA. Visual function and driving safety. Arch Ophthalmol. 1992;110:1697–8.

    Article  CAS  PubMed  Google Scholar 

  72. Kraft SP. Adult strabismus surgery: more than just cosmetic. Can J Ophthalmol. 2008;43:9–12.

    Article  PubMed  Google Scholar 

  73. Rogers GL, Chazan S, Fellows R, Tsou BH. Strabismus surgery and its effect upon infant development in congenital esotropia. Ophthalmology. 1982;89:479–83.

    Article  CAS  PubMed  Google Scholar 

  74. Pineles SL, Birch EE, Talman LS, et al. One eye or two: a comparison of binocular and monocular low-contrast acuity testing in multiple sclerosis. Am J Ophthalmol. 2011;152:133–40.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Pineles SL, Demer JL, Isenberg SJ, Birch EE, Velez FG. Improvement in binocular summation after strabismus surgery. JAMA Ophthalmol. 2015;133:326–32.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Pineles SL, Velez FG, Isenberg SJ, et al. Functional burden of strabismus: decreased binocular summation and binocular inhibition. JAMA Ophthalmol. 2013;131:1413–9.

    Article  PubMed  PubMed Central  Google Scholar 

  77. Pineles SL, Velez FG, Yu F, Demer JL, Birch E. Normative reference ranges for binocular summation as a function of age for low contrast letter charts. Strabismus. 2014;22:167–75.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Tandon AK, Velez FG, Isenberg SJ, Demer JL, Pineles SL. Binocular inhibition in strabismic patients is associated with diminished quality of life. J AAPOS. 2014;18:423–6.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Hengstler LK. The eye of the beholder. J Pediatr Ophthalmol Strabismus. 1991;28:301.

    CAS  PubMed  Google Scholar 

  80. Satterfield D, Keltner JL, Morrison TL. Psychosocial aspects of strabismus study. Arch Ophthalmol. 1993;111:1100–5.

    Article  CAS  PubMed  Google Scholar 

  81. Burke JP, Leach CM, Davis H. Psychosocial implications of strabismus surgery in adults. J Pediatr Ophthalmol Strabismus. 1997;34:159–64.

    CAS  PubMed  Google Scholar 

  82. Jackson S, Harrad RA, Morris M, Rumsey N. The psychosocial benefits of corrective surgery for adults with strabismus. Br J Ophthalmol. 2006;90:883–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  83. Hatt SR, Leske DA, Kirgis PA, Bradley EA, Holmes JM. The effects of strabismus on quality of life in adults. Am J Ophthalmol. 2007;144:643–7.

    Article  PubMed  PubMed Central  Google Scholar 

  84. Nelson BA, Gunton KB, Lasker JN, Nelson LB, Drohan LA. The psychosocial aspects of strabismus in teenagers and adults and the impact of surgical correction. J AAPOS. 2008;12:72–6, e1

    Article  PubMed  Google Scholar 

  85. Olitsky SE, Sudesh S, Graziano A, Hamblen J, Brooks SE, Shaha SH. The negative psychosocial impact of strabismus in adults. J AAPOS. 1999;3:209–11.

    Article  CAS  PubMed  Google Scholar 

  86. Coats DK, Paysse EA, Towler AJ, Dipboye RL. Impact of large angle horizontal strabismus on ability to obtain employment. Ophthalmology. 2000;107:402–5.

    Article  CAS  PubMed  Google Scholar 

  87. Goff MJ, Suhr AW, Ward JA, Croley JK, O’Hara MA. Effect of adult strabismus on ratings of official U.S. Army photographs. J AAPOS. 2006;10:400–3.

    Article  PubMed  Google Scholar 

  88. Mojon-Azzi SM, Potnik W, Mojon DS. Opinions of dating agents about strabismic subjects’ ability to find a partner. Br J Ophthalmol. 2008;92:765–9.

    Article  CAS  PubMed  Google Scholar 

  89. Berberat J, Jaggi GP, Wang FM, Remonda L, Killer HE. Changes in the amygdala produced by viewing strabismic eyes. Ophthalmology. 2013;120:2125–9.

    Article  PubMed  Google Scholar 

  90. Beauchamp GR, Felius J, Stager DR, Beauchamp CL. The utility of strabismus in adults. Trans Am Ophthalmol Soc. 2005;103:164–71; discussion 71–2

    PubMed  PubMed Central  Google Scholar 

  91. Hatt SR, Leske DA, Liebermann L, Holmes JM. Changes in health-related quality of life 1 year following strabismus surgery. Am J Ophthalmol. 2012;153:614–9.

    Article  PubMed  PubMed Central  Google Scholar 

  92. Kishimoto F, Ohtsuki H. Comparison of VF-14 scores among different ophthalmic surgical interventions. Acta Med Okayama. 2012;66:101–10.

    PubMed  Google Scholar 

  93. Hatt SR, Leske DA, Liebermann L, Holmes JM. Comparing outcome criteria performance in adult strabismus surgery. Ophthalmology. 2012;119:1930–6.

    Article  PubMed  Google Scholar 

  94. Hunter DG. Benefits of strabismus surgery in patients with one blind eye. Arch Ophthalmol. 1995;113:404.

    Article  CAS  PubMed  Google Scholar 

  95. Rosenbaum AL. The goal of adult strabismus surgery is not cosmetic. Arch Ophthalmol. 1999;117:250.

    Article  CAS  PubMed  Google Scholar 

  96. Kushner BJ, Fisher M. Is alignment within 8 prism diopters of orthotropia a successful outcome for infantile esotropia surgery? Arch Ophthalmol. 1996;114:176–80.

    Article  CAS  PubMed  Google Scholar 

  97. Parks MM. The monofixation syndrome. Trans Am Ophthalmol Soc. 1969;67:609–57.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Kushner, B.J. (2017). Strabismus Surgery. In: Strabismus. Springer, Cham. https://doi.org/10.1007/978-3-319-63019-9_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-63019-9_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-63018-2

  • Online ISBN: 978-3-319-63019-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics