Saturday, 5 March 2016

What to expect when your child has squint surgery (strabismus)

On 13 January this year, Scarlett had bilateral strabismus surgery - basically squint surgery on both eyes.
Although there are lots of images and technical articles on the web, I struggled to find anything that told me what to expect as a parent/carer so here goes....

Here is an example of Scarlett's eyes pre-op (apologies for the quality, it does get better) :


After many discussions with our opthamologist and the surgeon we decided to have the operation, despite it being cosmetic and that she will always have some form of squint.
I think this is because Scarlett's is quite strong and inter-changeable - but I'm not 100% sure.
We were told that it was an hour long operation, there was a chance of pain afterwards, she would need a week off school and four weeks off swimming.
The pre-op appointment ran really smoothly and the staff were lovely. Unfortunately Scarlett had burned her back the day before so we had been in A&E for a few hours before our appointment which meant she was pretty relaxed and bemused by the whole thing really. However the short film showing what would happen and how they put the drugs in was really helpful and settled plenty of the questions in my head.

The operation took place at 11am and Scarlett was third on the list (it runs by age at our hospital). We had DVDs to watch and the staff were in and out which kept the wait light-hearted. I went down to theatre with her so I was gowned up and saw them fit the canula (whilst she looked for Wally) and administer the drugs. Seeing her drift off into anaesthesia was incredibly difficult, even though I knew she was safe and fine. I cried all the way back to the room.

Thankfully we had packed to survive the longest-hour-of-our-lives-to-date with social media (Dan), crochet (me) and something to eat - we hadn't wanted to waft food under her nose when she had been starved since supper the previous evening.



No sooner had we settled into Despicable Me than the surgeon popped in to say the operation had gone well and she was wheeled back. But oh so drowsy, rubbing her eyes and crying - her tears were blood which was a shock to Dan (but was nothing to worry about). We kept her calm, called the family to say she was OK and then tried to manage her desperate desire for food and water and the hospital's need for these things to enter her tummy slowly......

This is her half an hour after waking up:



You can see the slight redness in the corner of both eyes where they operated.
Apart from a tiny spike in her temperature mid-afternoon she was totally fine and we were home by 4pm. We managed her pain with paracetamol and ibuprofen (the hospital gave me a sheet to fill in so that I could keep a track of what she had - this was really useful as I felt tired and confused by the end of the day so it was good to be able to see where we were). Unfortunately the eyedrops really stung so we had a bit of a battle getting these in, and she needed them three times a day. On the Great Ormond Street Hospital website it said you could put the drops in the corner of a closed eye so we did this - and promised her Hermione Grainger robes and a Hogwarts tie if she would let us do this for a week. It wasn't perfect administering but she got used to it and as she didn't get an infection I have to assume we got away with it.

This is Day Two:


You can see the eyes were very red. She struggled to watch telly or do anything for too long with bright lights. She complained of double vision and was on full painkillers. But she slept and ate quite normally.

Day Three:

Much less need for painkillers from here on. The double vision persisted and she needed her glasses from the moment she woke to when she fell asleep. We stayed at home and negotiated some half days with school to ease her back in.

Three weeks later, and you can hopefully see quite a difference:



For the first couple of weeks we could see the eye pulling when she focused, as if the brain and eye were trying to work together as previously. By this stage though the squint had been stabilised and if you compare the above image with the first you can see the progress. The double vision (which is apparently normal whilst the brain is receiving two images) had gone by this stage.

After four weeks we had a post-op appointment - everyone was happy and we have another in May (four months after the operation). Scarlett returned to swimming mid-February with no real problems (I think the pool at school made her eyes sting but our usual one doesn't) and she has returned to occasionally reading/watching television without her glasses on.

She managed the eye drops for six weeks and then we ceremoniously dumped them in the bin (I suspect she was dressed as Hermione).