Help with decision regarding a second surgery after the first one failed

[gal_aharon]

Please help us make an appropriate decision concerning a second eye surgery for my daughter. After being diagnosed with brown squint syndrome on her left eye.

My daughter (3.6 years old) had squint correction surgery. It was decided to do the surgery after several professional consultations because her head tilted to the left for the purpose of correcting her vision.

The surgical procedure included extending the superior oblique muscle (OS) to its maximum length of 8mm, since it was too short. Overcorrection was found in the postoperative review, so the surgery wasn't successful.

Before the surgery, her left eye didn't go up all the way when she looked up (see image 1).
And after the surgery, the left eye is higher than the right eye when the head is in a straight position (or when the head is tilted to the left). (see image 2)
She now tilts her head to the other side to correct a look.

The surgeon (professor) suggested performing a second surgery in which he wishes to "extend" the lower oblique muscle (IO) by moving its location over the eyeball.

Since this is a squint that is considered rare, there are not many professionals who have performed this type of squint correction surgery (Brown Syndrome).

Therefore, I am seeking any information that may make us feel more confident in the surgeon's recommendation.

Is the second corrective procedure he offered accepted and recognized?

Is there a more effective method for correcting the damage caused by the first surgery?

Are there any risks associated with the second surgery that do not justify the benefit it can provide?

[John C Hagan III, MD, FACS, FAAO]

1. Brown's Tendon Sheath Syndrome is rare and difficult to treat.  2. No there usually are no other therapies that work but more surgery   3. Many of even the much more common and easier to treat froms of squint like esotropia or exotropia require more than one surgery.  4. If you are not comfortable get a second opinion.