Squint surgery

A squint occurs when the muscles that control the movement of the eyes are too long or too short, causing the eyes to be misaligned and to look in different directions. One eye may look forward, while the other may look up, down or turn inwards or outwards. The condition is also known as strabismus or cross-eyes. A squint can occur all the time or intermittently.

Squints are common in childhood and affect around one in twenty children but can also occur in teenagers and adults. The cause of a squint is often unknown. Some babies are born with the condition, while in other cases a squint can develop later in life.

Untreated squints can cause double vision and may lead to lazy eye syndrome (amblyopia). Lazy eye syndrome occurs when the brain ignores input from the eye affected by the squint and can cause vision to deteriorate in that eye.

Some squints can be treated with non-surgical measures such as glasses, eye exercises, regular monitoring, and an eye patch to strengthen the lazy eye. If these treatments are not successful, surgery may be necessary to correct the squint.

What are the benefits of squint surgery?

There are several benefits of having squint surgery including:

• An improved appearance
• Correction of double vision
• Better peripheral (outer) vision
• In some cases, better depth perception

At your first consultation, you will be seen by a consultant ophthalmologist, a doctor specialising in conditions affecting the eye. They will typically be trained as a surgeon.

Your consultant will ask you about your symptoms, general health, and medical history, and perform a full eye examination. They may ask you to look at an object while covering one eye. This is to assess which eye turns, how much it turns and when the abnormal turn occurs.

At Circle Health Group, your first appointment is very important as it's where we get to know you, discuss your expectations for treatment and encourage you to ask any questions you may have. It is important to us that you are as well-informed and comfortable as possible before, during, and after your squint surgery, so please ask your consultant any questions you may have.

After making a diagnosis, your consultant will talk you through all the available options, including whether squint surgery could help you. Together, you'll build a bespoke treatment plan, tailored to your individual circumstances.

Your consultant will tell you everything you need to do to prepare for your squint surgery. If there's anything you're not sure about, or if you have any questions about how to prepare for your surgery, speak to your consultant or call the hospital for advice. Being well-prepared for your surgery will help to ease any anxiety you may have as well as allow your surgery and recovery to go more smoothly.

Before your surgery, tell your consultant about any medical conditions or allergies you have and any medication you are taking, including over-the-counter medicines.

Your consultant may tell you to stop taking some medications like blood thinners before your operation. This is to reduce the risk of bleeding during and after your surgery.

You will not be able to eat or drink anything from midnight on the day of your operation.

What lifestyle changes can I make before my surgery?

Being in optimal health before your surgery can reduce the risk of complications and speed up your recovery.

To make sure you are as healthy as possible before your surgery:

• Eat a healthy, balanced diet with plenty of fruit, vegetables, lean proteins, and whole grains
• If you smoke, try to stop at least eight weeks before your surgery
• Avoid alcohol for a few days before and after your surgery. Alcohol thins the blood and can increase the risk of bleeding
• Take regular exercise

Squint surgery is performed under general anaesthetic which means you'll be asleep for the procedure and won't feel any pain.

Once the anaesthetic has taken effect, the eye area is cleaned with an antiseptic solution. A device called a lid speculum is applied to your eyelids to hold them open during your surgery.

Your eye is rotated to allow your consultant to access the muscles that move your eyes. The conjunctiva (the layer of tissue over the white of the eye) is cut to expose the muscle.

Your consultant weakens or strengthens the muscles to align them, then they are fixed in place with dissolvable stitches.

Squint surgery normally takes between 40 minutes and an hour.

Sometimes squint surgery needs to be performed on both eyes to ensure they are correctly aligned. Your consultant will let you know ahead of time if this is the case for you.

After your surgery, you will be taken to the recovery room where your heart rate, blood pressure and breathing will be monitored closely until the effects of the anaesthetic have worn off.

Recovery from any type of surgery is different for everyone and depends on factors such as your age, general health and whether there were any complications during your surgery. Your consultant will be able to give you an estimated recovery timeline based on your individual circumstances.

When you wake up, you will have an eye pad over your eye to protect it. This is normally removed before you go home.

You will likely have some pain and discomfort and your eye may appear red and weepy after your squint surgery. Your healthcare team will give you medication such as painkillers and eye drops to help you feel more comfortable.

You will be given instructions on how to bathe your eye and apply eye drops in the weeks following your surgery.

Avoid rough or contact sports, swimming, and dusty environments for at least two weeks after your squint surgery. Do not use make-up around your eyes for at least four weeks after your surgery and don't use contact lenses until your consultant tells you it is safe to do so.

How many nights will I need to stay in hospital?

Most squint surgery can be done as a day case, meaning you'll go home later the same day. In some cases, you may need to spend one night in hospital.

Will I be able to drive home?

You will not be able to drive yourself home from the hospital after your squint surgery. Please make arrangements for someone to come and collect you. We can organise a taxi if you prefer, but it's important to have someone to help you when you get home.

How soon can I go back to work?

How soon you can go back to work after your surgery depends on how you feel after your surgery and the type of job you do. Most people return to work within a week or two of squint surgery.

How soon can I drive?

You should not drive for at least 24 hours after your squint surgery as the anaesthetic may not have fully worn off, and your reaction times may be impaired. After the first 24 hours, you can drive when you have no double vision and can safely control your vehicle and perform an emergency stop. This is normally a few days after your squint surgery.

When will I be back to normal?

Recovery from any type of surgery is a gradual process that is different for everyone. Most people can resume normal daily activities one to two weeks after squint surgery.

As with all types of surgery, squint surgery carries a small risk of complications. Your consultant will explain all the possible risks and complications before your surgery and answer any questions you may have about your procedure. Being as well-informed as possible about what to expect from your surgery will help put your mind at rest and allow you to make an informed decision so please ask any questions you may have.

Possible complications of any surgery include:

• Bleeding
• Infection
• Blood clots
• Adverse reactions to the anaesthetic

Possible complications specific to squint surgery include:

• The surgery may not be successful in correcting the squint
• Double vision - this is usually temporary, but in some cases is permanent and needs to be corrected with glasses
• Infection
• The eye muscles may move out of position and need to be corrected with further surgery
• A hole may develop in the eye after the muscles are stitched in place - this is treated with antibiotics to prevent infection and the hole may need to be closed with surgery
• Loss of vision - this is very rare and occurs in around one in twenty thousand cases

What a consultant ophthalmologist says about the risks of squint surgery

"The main risks of the surgery are that there may still be a squint after the operation because either too much surgery has been done or not enough.

"Some patients experience temporary double vision post-operatively, but in most cases this settles after a few days

"The eye will be red and gritty for a period after the surgery, but this is rarely a serious problem. If you have any concerns, please contact your consultant.

"All risks and complications will be discussed with you in full prior to your procedure."

Dr Alasdair Fern, consultant ophthalmic surgeon at Ross Hall Hospital.

We answer some of your most commonly asked questions about squint surgery.

Can a squint be treated without surgery?

In some cases, your squint can be treated without surgery. Non-surgical methods of treatment such as glasses and eye exercises are normally tried first. Your squint will be monitored to see if it is getting worse. If your squint doesn't improve with non-surgical treatments, your consultant may recommend surgery.

Can a squint come back after surgery?

There is around a 5% risk that your squint can come back after surgery. This is because surgery doesn't correct the defect that caused your brain to allow your eyes to drift in the first place. A squint may return shortly after surgery or years later.

Can I have laser eye surgery with a squint?

Laser eye surgery involves reshaping your corneas with a laser and is used to treat refractive errors such as long-sightedness, short-sightedness, and astigmatism. You can have laser surgery if you have a squint, but it will not treat your squint or affect it in any way.

How long does squint surgery take?

Squint surgery normally takes between 40 minutes and one hour.

How successful is squint surgery in adults?

Squint surgery in adults is normally very successful and around 80% of adults have satisfactory alignment after one operation.

Is squint surgery painful?

Squint surgery is performed under general anaesthetic which means you'll be asleep during the procedure and won't feel any pain. You can expect some soreness and discomfort for a few days after your squint surgery. Take over-the-counter painkillers like paracetamol or ibuprofen if you need to.

Is squint surgery safe?

Squint surgery is a relatively safe procedure, but as with all surgical procedures, there is a small risk of complications. Your consultant will explain all the possible risks and complications to you before your operation. It's important that you are fully aware of all the possible risks and complications before your surgery so that you can make an informed decision.

At Circle Health Group, we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group, you can expect the highest standards of care including:

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about squint surgery, book your appointment online today or call a member of our team directly.

Content reviewed by Circle in-house team in April 2023. Next review due April 2026.

1. Surgery: Squint, NHS
2. Squint (strabismus), Moorfields Eye Hospital NHS Foundation Trust
3. Strabismus, NIH
4. Correcting a squint (adult), Health Direct
5. The efficacy of strabismus surgery in adults: a review for primary care physicians, PubMed