Eye Muscle Surgery

These instructions from Children's Hospital of Philadelphia describe eye muscle surgery and how to care for a patient after the operation.

Important information:

The eye:

The eye is a very complex body part. Each eye is moved by 6 muscles. Each muscle has its own job and helps the eye move. These six muscles are used to look, up, down, left, and right and allow both eyes to focus on the same object.

The surgery:

During surgery, your surgeon will try to change the position of the muscles that are causing your child's eye to move the way it does. They may operate on one eye or both eyes. The team will tell you exactly what is planned before you sign the consent for surgery.

During the surgery it is necessary to make cuts in the conjunctiva, the clear covering of the white part of the eye, to reach the muscles.

What to expect after the surgery:

• Right after eye surgery your child may feel some nausea due to the anesthesia. In the recovery area, intravenous (IV) fluid and medicine will be given to help your child feel better. Once your child is in the recovery area, they may drink clear liquids.

• After surgery, your child's eyelids may be swollen. You may see "black and blue" marks around the eye. The eyelid swelling and bruising will take a few weeks to completely get better. The whites of the eye may be blood red. The eye redness may take a month or so to clear completely. Also, the eyes may not appear to be straight at first. This is normal. Eyes can take several days or weeks to straighten out.

• Your child's vision may be blurry for up to a week. They may have double vision for a week or longer. This is because the eye muscles have changed the eye's position. The eyes are now focusing in a different way. It is normal for some children to refuse to open their eyes for a day or so. An antibiotic ointment was placed inside your child's eyelids to prevent infection and reduce swelling. This may smear on the eye, causing blurred vision.

Instructions for care after surgery:

• Bright lights may bother your child. Please bring a pair of sunglasses or a brimmed hat for your child to wear on the ride home.

• At home, your child can resume their normal diet.

• Your child may have some bloody tears for a day or so after surgery. Gently wipe the tears away with a clean cloth.

• Once home, your child may keep glasses off while the eyes are resting. Restart wearing glasses once your child is comfortable opening their eyes again. Your healthcare provider will tell you if they want you to stop using glasses.

• Gentle eye rubbing after surgery is expected and okay. Please distract your child from rubbing their eye too roughly or too often. Please make sure that your child's hands are clean.

• Please call the Ophthalmology office at 215-590-2791 to make your follow-up appointment for 1-2 weeks after surgery.

Medicines:

Your child will be prescribed medicine with both an antibiotic and a steroid. It will help to prevent infection and reduce swelling. The medicine will be either an ointment or drops. Your healthcare team will teach you how to use it. Continue the medicine 3 times a day for one week.

If your child has pain after surgery, please choose one of the following options:

• Give acetaminophen, known by the brand names Tylenol®, Tempra®, or Panadol® by mouth every 4 hours as needed.

• Give ibuprofen, also called Motrin® or Advil®, every 6 hours as needed. Follow the dosage instructions on the bottle.

• If pain is not controlled with one medicine, you can alternate acetaminophen and ibuprofen. Write down the times that you give each medicine. You do not want to give too much of either medicine.

Preventing infection:

Keep bath water out of your child's eyes for one week. Wash your child's face gently with a clean washcloth. You may wash your child's hair if you rinse carefully from front to back.

For 2 weeks after surgery, do not allow your child to:

• Swim

• Participate in contact sports

• Play in the sand or dirt

• Play with glitter

Contact your CHOP healthcare team with questions, concerns or if your child has:

• Pain that is not relieved by acetaminophen or ibuprofen

• Fever greater than 101.3° Fahrenheit or 38.5° Celsius taken under the arm within 24 hours after surgery

• Vomiting lasting longer than 12 hours

• Swelling or drainage that gets worse after the first 2 days

• Worsening eye redness after the first 2 days

Division of Ophthalmology

Reviewed on April 1, 2023, by Ivy Kuhn, MSN, CRNP; Machelle Woolston, MSN, MHA, CPN, RN