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strabismus surgery outcome
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strabismus surgery outcome

I'm looking for help with my condition after having eye muscle surgery eight months ago. I'm 23 years old. Ever since my surgery for intermittent exotropia in my left eye, I'm left with constant double vision when I relax my eyes. I can bring the images together and make the double vision go away, but this does not last through a blink. I have bouts of dizziness as well as tiredness. My eye still noticeably drifts outward. It also will drift inward if I over focus, according to my surgeon (12 diopters). I am in good hands with my eye surgeon who is taking his time with me and has asked me to patch an eye. I have been patching a lens on my glasses for two months, nearly. Wearing the patch almost all hours of the day. He tells me that the patch will teach me to relax my eyes more so that he can get a true measurement when I see him for my appointments. It definitely seems to be working, because after reading for about thirty minutes, when I took my glasses off I looked around the room and noticed things that I had not noticed before.

While looking at a bedpost and turning my head from left to right, the image which my left eye sees will shift above the image that my right eye sees. This only happens while turning my head to the left and maintaining my eyes to the right. When I look straight ahead or to the left, the double images simply stay side by side.

I also notice this which worries me. Aside from recently noticing that the images are not just separated horizontally such as when I turn my eyes to the right to view an object, after reading for thirty minutes and then taking off my glasses with the patch, I noticed that things in the room seemed twisted. Parallel vertical lines (such as a bedpost) in the room were wide apart at the top and came together like a 'V' at the bottom. Picture frames in the room were twisted like one image was turned at a 45 degree angle and on top of the other image.

I searched online and found a term called 'skew deviation'. Is it possible that this has happened to me? Or the word 'torsion'? I read that skew deviations are a complication of eye muscle surgery but are reversible. Does this sound to be correct?

One last question that I would like to be answered about eye muscle surgery. I think my doctor told me a while ago that anything done during eye muscle surgery can be undone or redone. Is this correct? I ask because I see so much double and I'm worried about it. My surgery was only partially successful. My remaining outward drifting eye is still noticeable. And the double vision is too bothersome for me to live with. I believe the outward turn may be around 20 diopters, still. I have prisms of size 5, 7 and 10. The highest number that I can use is 17 if I combine the prisms. When I use 17 base in, there is still an outward drift along with double vision.

Can the terms 'torsion' and 'skew deviation' be explained to me? Does my description of what I see fit either term? Do I seem to have vertical diplopia when I look to the right?

Hopefully at my next appointment my surgeon will be able to answer my questions. But until then, may anybody help me with my situation at all? I'm quite concerned and very ready to be healed!

Thank you kindly for reading.
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233488_tn?1310696703
It's not likely you have skew deviation but your problems are extremely common after strabismus surgery. Keep working with your surgeon.
JCH MD
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All I can explain is that the double images I see when my eyes look to the right are different from the double images I see when I turn my eyes to the left or straight ahead. I noticed this a while ago but failed to mention it to my surgeon because I learned to overcome it. This is why he has me patching a lens on my glasses, so that I will stop overcoming my problem and that I can relax my eyes. Thank you doctor for your comfort, it is very appreciated. Hopefully simply another surgery to bring my eye inward more will correct the outward drift, and not worsen the inward drift that I also have when I try to overcome the double caused by the out drift. I find that after wearing the patch, my eye will tend to stay outward and not inward.

May I please ask you, if I look at a picture frame after taking my glasses with the patch off and one image is twisted from the other.. does this sound like 'torsion'? I'm worried because I've only begun to notice this since doing the patching. But I suppose I should continue to patch. I've been suspicious of vertical double vision since my surgery, but truthfully I grew up with this eye condition and also have good vision in both eyes. I thought the double vision was blurry vision when I was younger because I did not understand. But to my understanding, if images are side by side, it is horizontal double vision and if they are above or below one another it is vertical double vision. If this is the case, something is not right. Any more explanation, doctor? Thank you for your help thus far
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233488_tn?1310696703
IF the image is rotated that is a cyclo-deviation yes it look rotated.  With multiple strabismus surgery often they eyes may be straight in some fields of gaze and out of line in others, when out of line they over are in different degrees of misalignment depending on field of gaze.

Deviations often have a verticle AND a horizontial component and again often vary depending on which way you'r looking.

JCH MD
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