At the age of 28 I had eye muscle surgery for strabismus (esotropia).
I am now 33 years old. For quite some time I have been suffering from a bad outcome from
this surgery.
I have been trying vision therapy for about a year with very limited success.
I am trying to find help from someone out there. I truly believe there is something that
can be done.
It's a difficult situation to explain over the computer... but can you refer me to someone
or give me some kind of help. Is it possible to have a second surgery?
I need any help you can offer.
(Kevin Brocker)
Dear Kevin,
Thank you for your question. I apologize for the three months delay in answering the
question; we have a lot of strabismus research going on that literally absorbs me seven
days a week.
Despite the fact that you supplied little information I have no difficulty seeing that you
have a serious problem. You had surgery for esotropia at age 28, which is unusual. It may
be that either (1) you were not operated for a true esotropia as a child or (2) you
actually had esophoria, which means the eyes were straight most of the time, but you
occasionally saw double. In either case complaints after surgery is bad.
If you have complaints of double vision after surgery for childhood esotropia at age 28
(case 1), most likely the adaptation of the images in visual cortex ("anomalous
retinal correspondence") allows you to have single vision only when squinting
slightly inward. In other words, when the eyes are straight you see double, paradoxically.
This adaptation to strabismus occurs in the first years of life only. It can be modified
or extended only in the first years of life and it is the main reason to operate children
before they are 6 years old.
If there is double vision after the eyes are straightened or even overcorrected in a
divergent strabismus after the age of ten, the eyes have to be operated back into the
squinting position. This may very well be the only way to get rid or your current problem.
If it is, do not wait to long, because chances are that you have difficulty, after
surgery, to pick up the mechanism of suppression again to enable single vision.
Suppression of the central part or of the entire image of the squinting eye is also an
adaptation or the brain, developed in childhood, to avoid double vision.
If you, on the other hand, have complaints of double vision after surgery for esophoria
(case 2), the problem is quite different. These patients have normal or almost normal
binocular vision with full binocular perception of depth. However, they have difficulty
keeping there eyes aligned, either because the rest position of their eye muscles is
different from normal, or they have difficulty exactly fitting the images of the two eyes
on each other, to put it simply.
As these patients are having difficulty to get the two images together to begin with, it
is very important to be reluctant and careful in doing surgery in these cases.
Overshooting the target, i.e. to create a divergent squint, will lead to more complaints
than before surgery.
Please supply me with more details so we can work this out further.
(Herb Simonsz, MD, PhD)
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