Strabismus surgery is usually performed in about one hour, under general anesthesia, although some adults prefer to be awake, with local anesthesia and sedation.
During the surgical procedure, n incision is made in the clear membrane (called the conjunctiva) lining the white part of the eye. The rectus muscles are separated and moved to new positions to adjust their tension on the eye—creating more or less pull, whichever is necessary to straighten the eye position.
In what’s known as a “recession procedure,” the health care provider aims to relax a muscle with too much torque by moving it further back on the eye.
If a weak muscle is the cause of strabismus, the surgeon will vary their technique, adjusting the force of its opposing muscle to bring about balance.
Once the muscles are repositioned, they're attached with dissolvable sutures. Many ophthalmologists now use adjustable sutures, which allow them to fine-tune eye positioning after surgery.
With adjustable suture surgery (think: tiny slipknot), the surgeon—using only anesthetic eye drops in the recovery room—can tug the suture to subtly and painlessly shift the extraocular muscles until the eye is perfectly positioned.
