Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: Timing of a strabismus surgery

O Ehrt and MA Espinasse-Berrod

In order to better understand WHEN to operate strabismus it is essential to know WHY to operate strabismus, the natural history of the individual diagnosis, the age dependant risks of surgery and other treatment options.

Reasons to operate can be divided into psycho-social and functional aspects. The latter include: elimination of diplopia, improvement of stereovision, reduction of abnormal head position or asthenopia and rarely: improving amblyopia treatment, visual acuity or visual fields.

In infantile esotropia (syndrome) the chances of improving stereovision even with very early surgery is low. So most often psycho-social stress of the parents (with huge cultural differences between countries) and the child (starting not before school age) will be the major reason to operate. Delaying surgery to 5-6y will reduce the number of surgeries and perhpas the chance of coarse stereovision (Titmus fly) by 10% each. In cases of cross fixation surgery in the 2nd y is rarely advisable for functional reasons (head turn and improving amblyopia treatment).

In acquired esotropia in childhood (decompensated microtropia, partially accommodative, idiopathic) the child may have learnt some stereopsis before the onset of large angle deviation. So for functional reasons (regaining stereopsis), surgery should only be delayed by a few months after prescribing full hyperopic correction.

In "strabismus divergens intermittens" psycho-social stress in communication with other people is the most common reason to correct the deviation. Asthenopia (in adults) and loss of stereovision sometimes indicates the need for surgery.

Congenital motility disorders may cause abnormal head position. Thus surgery is advised for functional reasons: 1) within the first year of live in severe fibrosis syndrome (because secondary changes worsen the prognosis of delayed surgery), 2) after the second year of life in severe head tilt because of oblique muscle disorders or retraction syndrome and 3) early school age for Brown's syndrome (there may be spontaneous remission) and other moderate head positions including nystagmus (may change null zone earlier in life).

In acquired adult strabismus we should wait for recovery of cranial nerve palsies for 1 year, and 6 months in stable Graves' orbitopathy.

Many different aspects including a careful history of patients psycho-social and functional stress have to be taken into account to

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability