Strabismus pp 193-207 | Cite as

Complications of Eye Muscle Surgery

  • Burton J. Kushner


Although it is normal to have some degree of pain and irritation after strabismus surgery, one must always be attentive to the remote possibility of a cellulitis, which requires systemic antibiotics, or the even more remote possibility of endophthalmitis. Usually, swelling and discomfort are most prominent the morning after surgery and improve as the day progresses. However, if the symptoms are worsening, and particularly if the pain is of a deep nature, as opposed to surface irritation, the patient should be seen to rule out a serious problem. Common causes of surface pain include suture irritation (if conjunctival sutures were used), deleon formation, or filamentary keratitis. For reasons that are not clear, preseptal cellulitis can occur and is more common than orbital cellulitis after strabismus surgery. One also must consider an allergic conjunctivitis to be the cause if postoperative topical antibiotics were used. If bilateral surgery was performed, and the irritation is unilateral, you are not dealing with an allergic problem. Treatment of allergic conjunctivitis includes discontinuing the offending medication, and if severe a short course of mild topical steroids.


Anterior segment ischemia (ASI) Capsulopalpebral head Cellulitis Cysts Diplopia Disinserted muscle Dry river bed sign Dynamic imaging Elongated scar Endophthalmitis Imaging Infection Lost muscles Myotomy Pulled-in-two syndrome Scleral perforation Slipped muscle String test Thyroid eye disease (TED) Vessel sparing Z-myotomy 


  1. 1.
    Ing MR. Infection following strabismus surgery. Ophthalmic Surg. 1991;22:41–3.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Gottlieb F, Castro JL. Perforation of the globe during strabismus surgery. Arch Ophthalmol. 1970;84:151–7.CrossRefGoogle Scholar
  3. 3.
    McKeown C, Lambert H, Shore J. Preservation of the anterior ciliary vessels during extraocular muscle surgery. Ophthalmology. 1989;96:498–506.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Hayreh SS, Scott WE. Fluorescein iris angiography. II. Disturbances in iris circulation following strabismus operation on the various recti. Arch Ophthalmol. 1978;96:1390–400.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Kushner BJ. Subconjunctival cysts as a complication of strabismus surgery. Arch Ophthalmol. 1992;110:1243–5.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Parks MM. Slipped, disinserted or severed, and lost muscles. In: Rosenbaum A, Santiago AP, editors. Clinical strabismus management. Philadelphia: W. B. Saunders; 1999. p. 529–38.Google Scholar
  7. 7.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Cibis GW. Incidence of inadvertent perforation in strabismus surgery. Ophthalmic Surg. 1992;23:360–1.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Noel LP, Bloom JN, Clarke WN, Bawazeer A. Retinal perforation in strabismus surgery. J Pediatr Ophthalmol Strabismus. 1997;34:115–7.PubMedGoogle Scholar
  10. 10.
    Ludwig IH, Chow AY. Scar remodeling after strabismus surgery. J AAPOS. 2000;4:326–33.CrossRefGoogle Scholar
  11. 11.
    Kushner BJ. A surgical procedure to minimize lower-eyelid retraction with inferior rectus recession. Arch Ophthalmol. 1992;110:1011–4.CrossRefGoogle Scholar
  12. 12.
    Kushner BJ. The effect of anterior transposition of the inferior oblique muscle on the palpebral fissure. Arch Ophthalmol. 2000;118:1542–6.CrossRefPubMedGoogle Scholar
  13. 13.
    Kushner B. The efficacy of strabismus surgery in adults: a review for primary care physicians. Postgrad Med. 2011;87:269–73.CrossRefGoogle Scholar
  14. 14.
    Kushner BJ. Intractable diplopia after strabismus surgery in adults. Arch Ophthalmol. 2002;120:1498–504.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Burton J. Kushner
    • 1
  1. 1.Department of Ophthalmology and Visual SciencesUniversity of Wisconsin-MadisonMadisonUSA

Personalised recommendations