possible second eye muscle surgery

[stacey2286]

I had my first eye muscle surgery a year and a half ago at the age of 23. My left eye drifted outward with minimal double vision before surgery. I have 20/20 vision in both eyes. The inner muscle was tightened and the outer muscle was loosened during my surgery and an adjustable suture was used and adjusted the following morning. My eye was a little bit too far inward after surgery. I have a large amount of double vision since this surgery which results in headaches, fatigue and dizziness. I've tried several different approaches short of surgery. A small amount of torsion and a small amount of hypertropia has been measured since my first surgery. And my eye is drifting back out to where it started around 25pd. My eye also will drift inward at times since my surgery which has my doctor confused. This never happened before my surgery. I'm curious if all aspects of this condition are even possible to correct. Can torsion, exotropia and hypertropia be corrected? One therapist sounded grim. She said it's very likely I'll have postoperative diplopia while looking to the sides after another surgery. She seems to believe that I will be doing a tradeoff by having another procedure done. I've heard of a mini tenotomy also. I'm willing to do anything to possibly have this condition corrected. The eye strain while reading is very intense.

The torsion and hypertropia that I notice are well controlled but when I allow it to occur, it can become VERY visually confusing. The therapist who works with my strabismus surgeon says it's unavoidable often times to have results like mine. I'm curious if it is even possible correct. I told my doctor this: "I'm not one to go bungee jumping". I've had one surgery that has had its complications but understand the risks and also understand that it's common to need more than one surgery. I'm ready to go forth. However, nervous.

Thank you for your help.

[stacey2286]

Thank you doctor. I'm just curious to know if it happens often when a patient may have double side to side. From what I read when I research online, it isn't common. My doctor mainly has stressed the importance of me understanding that a second surgery still may not be sufficient and there's always a possibility of more surgeries in order to get satisfactory results. I had little to no double vision prior to surgery. Just an eye that would drift outward and the vision would suppress usually even though both eyes see 20/20

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

1. Yes the results you obtained are not unusual.
2. I cannot comment on the advantages or disadvantages of more surgery.
JCH MD

[stacey2286]

Do you believe it is common to have these results after an eye muscle surgery and that more surgery may help to relieve my symptoms or the drifting eye? My ophthalmologists therapist believes I may be doing a trade off for single vision straight ahead by having double side to side after having another surgery. This frightens me. I'm planning to schedule an appointment with another strabismus specialist for another opinion but very much appreciate advice that you may give to me.

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

My bad. I read it "hyperopia"  Yes the advise still stands. Get a second even third opinion. You have a very difficult problem.

JCH MD

[stacey2286]

By hypertropia, I mean a tiny amount of upward drifting of my eye as well as torsion (twisting) of my eye so that the images I see sometimes drift out, up, and rotate a little bit. Prisms haven't given me much relief.

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

Your problems are not uncommon post exotropia-phoria surgery. Hyperopia is a refractive condition that is sometimes treated with glasses however at  your age glasses are usually not necessary and if you would glasses would make your eye turn out more.

I suggest a second opinion from another strabismus specialist. Prism glasses might be of some help.

Each further surgery is more difficult to predict.

JCH MD