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