Double vision from strabismus surgery

Hi all,

Since birth, I've had scarring on my left retina from toxoplasmosis. I have
some peripheral vision remaining in the eye, but can't see well enough to
read, for example. This also resulted in my left eye turning outward --
enough that people sometimes had a hard time knowing where I was looking.

A week ago I had eye muscle surgery to correct the turn, and since then I've
been experiencing double vision. I can get around okay and can read, etc,
but the double vision is still disorienting and very frustrating. I would
not trust my vision to drive a car at this point.

I'm very pleased to have straight eyes, but how long should I expect the
double vision to last? If it doesn't go away, what options are there for
treatment?

Thanks,
-CF

 

1. In exotropia, the usual early postop goal is to leave it a little turned
in, since as it heals, it tends to go out a bit - overcorrection caused
diplopia, usually.

2. Your system may be long-term adapted to angling out, and takes time to
adapt to being straight. However, not everyone is able to adapt.

3. If the overcorrection persists, or if there is diplopia just from being
straight, prism in your glasses can help move the image over a bit and help
the diplopia. Your ARE wearing polycarbonate glasses all the time, right?
(for eye protection). BOTOX can also move the eye back a little to towards
the original angle and help the diplopia, or in some cases, additional
surgery is needed.


David Robins, MD
Board certified Ophthalmologist
Pediatric and strabismus subspecialty
Member of AAPOS
(American Academy of Pediatric Ophthalmology and Strabismus)

 

Thanks for your reply, David. Just a few questions in response to your
comments:

The adaption you're referring to would be suppression in my case, right?
Does suppression invariably lead to loss of depth perception? I had
sufficient depth perception prior to the surgery, and I'm beginning to fear
that I could be doing damage to my vision.

Will prisms negate the cosmetic benefit of the surgery?

-CF

 

Supression would have been there prior to the surgery, since your eyes were
not straight, and you weren't seeing double. I meant that you were adapted
to the abnormal angle, and it can take a while to get used to being straight
- often due to having "abnormal retinal correspondence" (ARC), where the
brain has rewired corresponding areas. If your eyes weren't straight prior
to surgery, there would have been little if any true stereoscopic vision.
You may feel there has been a change in your adapted depth perception, and I
don't know haw you will find it once all has healed and readapted.

Prisms won't negate the surgery, assuming what you have it is small,
[possibly temporary, overcorrection. Using prisms to eliminate diplopia if
the eyes ARE straight does cause a small shift int he apparent angle of the
eyes, but is usually not cosmetically obvious unless the are so large that
they are undoing a lot of the surgery, but that would lead to huge prisms
that would be unwearable anyway.