5 year old Jake, and mum Kirsty, came to see Dr Dawn about a problem with Jake’s eyes.
Does it bother him?
With his glasses off. He hates having his glasses off because it takes him a long time to focus, because he’s long-sighted as well so that doesn’t help.
The family check in to the eye hospital at Adam Brookes Hospital. An orthoptist takes Jake through a number of tests to measure the extent of his squint.
Look again, you’re nearly right, look again.
What’s underneath that L?
Umm, a curly c?
A curly c.
These results get passed to Miss Louise Allen, a specialist eye surgeon, who explains how she’ll straighten Jake’s eyes.
So when we do the operation to correct the squint, we are weakening one of the muscles in the eye and what we do is take the muscle off and pop it back on the eye, sew it back on about 6mm back, which loosens the muscle, makes it less efficient.
You mean you have to break the muscle off?
I put it back on again, don’t worry, it should be fine.
It’s in the wrong place, so it’s making your eyes go funny.
It’s a little bit tight at the moment, so we have to weaken it, make it a bit looser. Alright? And that will stop making your eye turn in.
It’s going to be sore for at least 24 hours, and they are quite miserable to start with, but they usually sleep fairly well the first night and after that it’s usually fine. It’s just the first bit of the day after the operation, and the trick is really, we give you some calpol and some nurofen, to take that you have to keep going quite regularly for the first 48 hours or so. But after that it’s ok. So are you going to see me early in the morning? And don’t sneak any food ok?
It’s the day of surgery and despite Jake’s smile he’s a little apprehensive.
Today’s operation day and we are waiting for him to go down at the moment. Just hopefully everything will go well and we can take him home this afternoon. Feeling a bit scared or are you ok? Little bit scared?
Little bit scared.
Alright, if you’d like to go through, if you’d like to follow me.
First Jake is given an anaesthetic gas to make him go to sleep. the operation he’ll be having is called a bimedial recession and is expected to take 30 minutes.
Jake’s eye is clamped open, and a traction stitch is made to give Dr Allen, complete control of the eye during the operation.
The first stitch I am going to do is the traction stitch to hold the eye over, so I can get to the muscle which is on the inside corner of the eye here. Now I’m going to make a little cut in the outer coating called the conjunctiva, that covers the eye. That’s the bit that gets inflamed when you get conjunctivitis. That’s the muscle right there, that’s the one that’s over working for him. Squints are pretty common, they affect about 5% of the population. The most important thing about squints is that if you catch them early enough, you can often, especially with childhood squints, you can often stop the child from needing surgery from correcting them with glasses. So it’s quite important that if you notice a child over the age of 6 months squinting from time to time to get it checked out. Unfortunately, for Jake he wont be able to use his eyes together, although I can make them look a lot straighter. And that’s mainly because he has already lost that ability by the time his squint was noticed really. This means he’s got a higher chance of needing future squint surgery, about 30% chance of needing some more surgery at another time in his life, in adulthood because the eyes wont be working together. But we can prevent that happening if we can prescribe glasses early. So we are now going to cut the muscle off its original place of insertion onto the eye, so we are going to measure back from the original place of insertion here, so Neil is marking me a little mark with the ruler, so I can see how far back I am moving it. So I am going to secure it on to the eye here. And then what you should be able to see here is the muscle further back from it’s attachment before. For the type of squint that is due to long sight, if Jake had been able to come and been given long-sighted glasses at a very early age, when he was just starting to squint, it would have probably prevented him from needing this operation. They squint without their glasses, but with their glasses their eyes are straight, and they get 3D vision. Unfortunately, Jake has lost his potential to see in 3D vision, which is a shame really.
The specialist repeats the same procedure on the other eye.
Jake’s operation went very well indeed, completely routine. He’s going to be a little bit sore for a couple of days, but after that really he should adjust to it quite well. He’s got some drops to use for about a week or so, that will just calm the eye down, make it feel more comfortable. So he should be able to see fine from when he wakes up. There’s usually a little bit of screaming for the first few hours but after that he should be fine.
Jake was treated as a day case, so after a few hours in recovery, he was free to go home, and back to school a few days later.
Jake: I can see!
4 weeks later and mum, Kirsty, has noticed a big difference since Jake’s operation.
It took him a while to recover, and his eyes were really sore afterwards, but now they are a lot better focused. They look nicer, whiter, not so red and patchy in-between. Had we not have had the operation for him they would have probably got worse. He was having troubles concentrating and things before, now he seems to be a lot better at concentrating, he doesn’t seem tired all the time.
Jake had a marked convergence squint, which meant his medial recti, the main eye muscles, were over-working, causing his eye balls to move inwards. After a 30 minute operation to weaken these muscles he now has more control over his eye movements, resulting in a straighter eye alignment.
It was a bit stressful, like any operation is for anybody I suppose. I think we are quite happy that we went through with the operation and we are happy with the results.
We take an in detail look at the operation to correct a childhood squint.
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