Exotropia post-Lasik

[blrusso]

It's been two years since I had Lasik surgery.  Ever since I had the surgery, I started to have eye pain, headaches, difficulty reading and focusing, and what I described as a "pulling" sensation in my eyes.  Finally, I've been to see some strabismus specialists who have diagnosed high intermittent exotropia.  I'm currently up to wearing 16 diopters of prism in my glasses, and each time they increase the amount, I feel a little closer to normal, although even with the prism correction, my eyes still feel funny and sometimes hurt.  

My questions are:

1) Is there an understanding of how Lasik surgery can trigger exotropia of my magnitude?  I had never been diagnosed with strabismus previously, either as a child or before surgery; but after Lasik, I have the problem.  I have seen other cases mentioned online.  What's the explanation and shouldn't doctors be warning Lasik patients?

2) Is surgery recommendable in my case?

Thanks,
Brent

[Ray T Oyakawa, MD]

This may happen after LASIK or cataract surgery.  This can be corrected by muscle surgery.

Dr. O.

[greg231]

Brent,

I am having the same problems. Two years after my Lasik surgery I started noticing headaches and double vision. I have since been diagnosed with intermittent exotropic strabismus.  I didn't have history of exotropia prior to surgery. What have you learned about any potential links between Lasik and exoptria?  Any info would be helpful.

Thanks,
Greg

[blrusso]

Dear Dr. Oyakawa,

Thank you for your comment.  Is there an understanding of how it happens?  Does simply changing the focusing orientation of the cornea change the convergence orientation as well?  Or does it have something to do with the mechanics of the procedure itself?  Or something else?  

I can tell you I've been pretty miserable for over two years.  This is a serious, difficult-to-treat condition that I had no idea I might end up with.

Going forward, I also have questions about the effectiveness of prism glasses.  I currently wear 16 diopters of prism in my glasses, and this seems to have provided some relief compared to wearing nothing, although my eyes still feel pulled and strained, and still hurt in the afternoons, evenings, and nighttime.  I notice that I get a similar amount of double vision and intermittent deviation once I've worn the glasses for a while that I have before I put the glasses on in the first place.  Does prism just artificially move the eyes out, without actually curing the exodeviation?  Or does prism "unlock" latent exodeviation that is naturally there?  If I keep increasing the amount of prism, will the exodeviation ever go away?  Is surgery any different from prism in terms of its effectiveness?  

Hopefully these questions make some sense.  This has been the worst thing that's ever happened to me--my life has not been the same since I had Lasik surgery, and I fear it may never be the same again.

Brent

[blrusso]

Dear Dr. Oyakawa,

Thank you for your comment.  Is there an understanding of how it happens?  Does simply changing the focusing orientation of the cornea change the convergence orientation as well?  Or does it have something to do with the mechanics of the procedure itself?  Or something else?  

I can tell you I've been pretty miserable for over two years.  This is a serious, difficult-to-treat condition that I had no idea I might end up with.

Going forward, I also have questions about the effectiveness of prism glasses.  I currently wear 16 diopters of prism in my glasses, and this seems to have provided some relief compared to wearing nothing, although my eyes still feel pulled and strained, and still hurt in the afternoons, evenings, and nighttime.  I notice that I get a similar amount of double vision and intermittent deviation once I've worn the glasses for a while that I have before I put the glasses on in the first place.  Does prism just artificially move the eyes out, without actually curing the exodeviation?  Or does prism "unlock" latent exodeviation that is naturally there?  If I keep increasing the amount of prism, will the exodeviation ever go away?  Is surgery any different from prism in terms of its effectiveness?  

Hopefully these questions make some sense.  This has been the worst thing that's ever happened to me--my life has not been the same since I had Lasik surgery, and I fear it may never be the same again.

Brent