How is realignment surgery for the eyes performed?Do they take my eye out of my !

How is realignment surgery for the eyes performed?Do they take my eye out of my head?

There are lots of ways that strabismus surgery is performed. Basically there are two spheres, the two eyes. On the right side of each sphere is a muscle that when pulled, the sphere rotates towards that muscle. Same for the left side. When the left muscle of each eye contracts, the eyes move towards the left..

Assuming that no vertical muscles are involved (they move the eyes up and down), if the operation is on one eye only, the muscles are moved so that the eye is repositioned so the two eyes are in alignment. Both face the same direction at the same time.

So if, for instance, the right eye is not looking straight, but is looking to the left when the left eye is looking straight, and the decision is to operate just on the right eye, not both, they do it this way:

The covering of the eye is called the conjunctiva. It's the part that gets all red when people get pink eye or conjunctivitis.

That part is opened, and the muscle towards the temple (lateral rectus muscle), is hooked with a 'muscle hook'. The eye is rotated towards the nose by pulling on this muscle hook. Sutures are placed into the tendon that attaches the muscle to the white part of the eye. The muscle is then cut where it goes into the eye leaving the muscle attached just to the sutures. On the surface of the eye is a little tendon stub that's left when the muscle is cut away.

The same thing is done for the nasal muscle (medial rectus muscle).

So now the eye has no horizontal muscles attached. The eye is rotated outward, and the nasal muscle is moved back a certain amount and reattached to the surface of the eye. It's usually moved back one of three distances (a little bit, a whole lot, or an in between amount), depending on the surgeon, the amount of rotation desired, etc. Some people measure exactly so many millimeters back or forwards.

After the nasal muscle is re-sutured to the eye, being now further back than it started by 3-6 mm or so, the lateral rectus muscle is reattached. This muscle is moved forward and the 'belly' of the muscle is reattached to the place where the tendon used to be attached, the little stub left when the muscle was removed), and the part of the muscle that is in excess, is resected or cut.

So the later muscle is resected, and the medial muscle is recessed. The surgery is called an R & R for those two words.

Then the conjunctiva is re-sutured, some medicine to avoid infection is placed and the eye patched.

When the patch is taken off, the two eyes will be the same direction.

Sometimes just the two nasal muscles, the medial rectus muscles are recessed, which allows both eyes to move out a small amount, which may be enough to align the eyes in the same direction. That's called a 'bilateral recession'.

There's a lot of sensory physiology that now comes into play to keep the two eyes aligned. If it's underdone, and the eye is still even a little bit crossed, it'll move back in with time.

The surgery itself takes about half an hour, if one moves slowly.