Strabismus Surgery: After the Operation
A strabismus surgery (squint surgery) is often the decisive step in realigning deviating eyes or facilitating binocular vision. But what actually happens after the procedure?
TL;DR
Follow-up appointments shortly after surgery:
The first ophthalmologic check usually takes place on the day of the surgery, once the patient is awake. During subsequent examinations in the first few days, the new eye alignment and the healing process are carefully assessed.
Normal symptoms in the first days:
A red, bloodshot eye, a foreign-body sensation (as if there were “sand in the eye”), and mild pain are completely normal in the first few days. Bloody tears or double vision can also occur and are not unusual.
Healing time and rest:
The conjunctival sutures dissolve on their own within a few days, and the redness subsides after several days. Physical rest is recommended for about 1–2 weeks. Sports, strong vibrations, and heavy lifting should be avoided initially. Children usually stay home for a few days before returning to school, daycare, or kindergarten. Forest kindergarten, sports, or swimming should be avoided for two weeks.
Recognizing warning signs:
Complications are very rare. However, if there is a sudden increase in pain, severe vision loss, or other unusual symptoms after the initial recovery—or if eye movement becomes restricted—a prompt eye examination is required.
Immediately After the Strabismus Operation
After the procedure, patients are monitored in the recovery room. Once fully awake, the ophthalmologist performs a short initial examination to assess whether the eye alignment was corrected as intended.
Children and adults can usually go home the same day if they feel well and are fully awake from anesthesia. Only rarely (e.g., with very young children or special medical conditions) is an overnight hospital stay required.
The day after surgery, a more detailed check-up takes place. The new eye alignment is measured and documented. Small deviations and double vision are normal. The alignment often changes in the first few weeks. The long-term result stabilizes only as healing progresses, so patience is needed. The first measurement serves as a baseline, but it doesn’t reflect the final outcome.
Patients also receive instructions for postoperative care, including how to use eye drops or ointments in the days following surgery. Usually, an antibiotic and sometimes a mild cortisone preparation are applied directly after the operation to prevent infection and inflammation. Parents of young children are shown how to continue applying drops or ointments at home.
On the day of the operation, the child may be reluctant to open their eyes due to the foreign-body sensation. This is normal. Parents should not force the eyes open. Cooling the eyes gently with a cold pack can help. If the eyes remain closed, ointments can be temporarily skipped until the child opens their eyes again without difficulty.
Typical Symptoms in the First Days
Some level of discomfort after strabismus surgery is normal, including:
1. Redness of the eye:
The white of the eye (conjunctiva) is reddened due to small, normal postoperative bleedings. The redness may increase slightly in the first 3–4 days and then gradually fade. The eyelids may also appear mildly swollen.
2. Foreign-body sensation and irritation:
Many patients say it feels as though a grain of sand is in the eye. This is caused by the fine sutures of the conjunctiva rubbing slightly under the eyelid. These stitches are necessary to close small incisions and are made of dissolvable material, which disappears after a few weeks. The irritation usually eases by the second day as the sutures soften. Artificial tears can provide relief if the eye feels scratchy.
3. Mild pain:
Right after waking up, the eye may sting or ache, similar to conjunctivitis. The pain is usually mild to moderate and often described as “soreness” or “muscle ache.” Painkillers like paracetamol or ibuprofen can be taken if needed. In children, signs like restlessness, crying, or eye rubbing may indicate pain. Consult your doctor about suitable medication (e.g., ibuprofen suspension). The key point: pain should lessen each day. Increasing or severe pain despite medication is unusual and should be checked by a doctor.
4. Minor bleeding:
In the first few days, slightly bloody tears may appear at the inner corner of the eye or on tissues. Though dramatic-looking, this is usually harmless, similar to a small scraped wound. As long as bleeding is mild and temporary, there’s no need for concern. Normal blinking and gentle wiping with sterile gauze or a clean, lint-free tissue is sufficient. Persistent or heavy bleeding should be checked but is very rare.
5. Double vision (diplopia):
Temporary double vision after surgery is common, and can actually be a positive sign that both eyes are working together again. It occurs because the brain hasn’t yet adapted to the new alignment. Older children and adults often notice that “everything looks double” at first. This happens because the eyes are newly aligned and the brain must re-coordinate.
Surgeons may even intentionally overcorrect slightly, accepting short-term double vision to achieve the best long-term result. These double images usually disappear within a few days as the brain adjusts. In adults, the adaptation can take longer, but double vision still typically improves markedly with time.
Wound Healing and Physical Rest
Although strabismus surgery affects only the outer eye (not the inside), the eye needs time to heal. The conjunctiva and eye muscles adjust in the first weeks after surgery. During this period:
Physical activity
Avoid strenuous activity in the first week, no sports, heavy lifting, or rough play. Children should be protected from bumps or objects near the eye. For adults, return to work depends on the job: office work can resume after a few days, but physically demanding or high-risk jobs (e.g., healthcare, construction) require longer rest. Gentle walks and daily light activities are fine as long as you feel well. Anything that raises blood pressure significantly or risks injury should be avoided at first.
Swimming, sauna, bathing
Avoid public swimming pools for about 2–3 weeks, as chlorine and bacteria can irritate the healing eye. Similarly, saunas and steam baths are discouraged for the first weeks due to heat and humidity increasing circulation and inflammation risk. Showering at home is fine, just avoid getting soap or shampoo in your eyes. Tilt your head back or ask for help when washing hair.
Screen time and reading
Unlike some other eye surgeries, there’s no strict restriction on reading or screen use. You may read, watch TV, or use a computer when you feel comfortable. However, the eyes tire more easily for 2–3 days. Take frequent breaks, and if your eyes burn or feel strained, rest them. Some clinics advise avoiding long reading sessions for the first few days to prevent overexertion. Short reading or phone use is fine, just don’t force concentration if it feels uncomfortable.
Everyday life and childcare
Children can usually return to school or kindergarten within a few days once they feel well and vision is stable. A parent should stay home initially to help with eye drops and prevent rubbing. Adults may need more breaks during computer work and may use artificial tears more frequently. Those working in dusty or physically demanding environments should stay home for about a week.
Eye protection
Usually, no bandage is needed after surgery. The eye should remain open and mobile, but avoid rubbing or pressing on it. If it itches, use lubricating drops or a cold pack instead. Outdoors, sunglasses are helpful to protect against bright light and wind, which can feel irritating to healing eyes.
Follow-Up Care and Checkups
Regular ophthalmologic follow-ups are essential after strabismus surgery to monitor healing and ensure the eye alignment remains stable. The schedule may vary, but typically:
- First check immediately after surgery.
- Next-day examination: A detailed check-up is done the day after surgery to measure alignment and rule out complications. Pain, double vision, and general well-being are discussed. If all is well, the doctor gives further instructions.
- Follow-ups in the first weeks: Usually another exam occurs about 7–10 days later to check healing, then every 4–6 weeks. These are important, as eye alignment can still shift during this period.
- Long-term check (≈3 months): By three months post-op, results are typically stable. This exam determines whether the desired outcome has been achieved and if further treatment is needed.
Adjustable suture technique:
In some cases (mainly adults), surgeons use an adjustable suture technique. This allows the muscle position to be fine-tuned under local anesthesia within 24–48 hours after surgery to optimize alignment and reduce double vision.
Double Vision After Surgery – Normal or Not?
Double vision (diplopia) worries many patients, especially adults. Initial double vision is common and usually a positive sign. It means both eyes are working together again and the brain is trying to fuse the images.
Children who previously suppressed one eye may not notice double vision right away, since their brain still “ignores” that eye. They first have to relearn binocular vision.
In contrast, teens and adults who previously had normal binocular vision often see double immediately after surgery. This is temporary and expected.
How long does double vision last?
In most cases, it disappears within a few days as the eyes heal and the brain adapts. If significant double vision persists for several weeks, the ophthalmologist will reassess and discuss next steps.
Rarely, if a residual strabismus remains after full healing and cannot be compensated, a second surgery may be considered, typically only after 6–12 months. Early re-operations are rare (~5%). Over time, however, strabismus can recur, and around 20% of patients benefit from another corrective surgery, sometimes decades later.
Book an appointment
Do you have further questions about strabismus and possible treatments, or would you like to schedule a consultation? Our team at FIRST SIGHT, directly at Zurich Main Station, will be happy to assist you.
Further Information
Strabismus Surgery in Children: Everything About Pediatric Strabismus Operations
Conservative Treatment: Non-Surgical Treatment for Strabismus
