Squint Surgery in Children. Patient Information

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1 Squint Surgery in Children Patient Information Author ID: KW Leaflet Number: Orth 014 Version: 4 Name of Leaflet: Squint Surgery in Children Date Produced: August 2014 Review Date: August 2016

2 What is a Squint? Squint is a common name for strabismus which is a medical term to describe that the eyes are not pointing in the same direction The squint may be present all or some of the time and it may be in one eye only or swap between the two eyes The aim of surgery is to put the eyes into a straighter position. Surgery does not have an effect on the need for glasses and patching and these may still be needed after surgery. The orthoptist will discuss this with you. The possible reasons for squint surgery To allow the eyes to work together To relieve double vision To improve the appearance by making the squint less obvious Pre-operative assessment Once a date for squint surgery has been offered, you will be sent an appointment for an Orthoptic Pre-operative assessment to measure the size of the squint. Rainbow ward offer a pre-operative assessment with the hospital play specialist prior to day of admission. Children who attend this are usually better prepared and have a better experience of their hospital stay. If you would like to attend one of these sessions please let us know so that we can arrange this. Fasting Information As your child will need a general anaesthetic it is important that they do not have food or drink in advance of the surgery. If the surgery is in the morning No food after midnight the night before. Your child may have a small drink of water up until 2 hours before surgery. If the surgery is in the afternoon No food from 7.30am on the day of surgery. Your child should be encouraged to drink water up until am. On the day of admission Arrive at Rainbow ward on the morning of the surgery: you will be informed of the time by letter. It is however, important that you ring the ward before coming to hospital to check that there is a bed available: their telephone number is /3. If your child has a favourite teddy or toy that they sleep with, please bring it along with them to help them feel more comfortable. Squint Surgery In Children Page 2 of 7

3 If you would like to bring pyjamas, slippers & dressing gown you are more than welcome: please do not buy especially, as we have special children s gowns that can be worn. A nurse and a play therapist will carry out an assessment. It is important that you inform them of any medication your child takes, if they have any allergies or are not well on the day. Your child will be seen by the anaesthetist and surgeon on the ward before the surgery. In line with local governance procedures, in the majority of surgical cases your surgeon is required to mark the operation site preoperatively with a marker pen. This forms part of the checking procedure and is a national safety guideline A white cream called EMLA will be put on the back of your child s hand or arm. This will numb the area ready for the anaesthetic. You are encouraged to be with your child in the anaesthetic room whilst they go to sleep. Once surgery has been carried out you will be able to go the recovery room with the nurse to bring your child back to the ward. Car Parking When you park at the hospital you can pay the lowest fee and once you arrive on the ward ask your staff nurse for a concessionary pass which will cover you for the whole day. What happens during the surgery? There are six different muscles attached to the eyeball and the surgery will involve adjusting the balance of these muscles. The muscles are hidden under the conjunctiva (a thin cover over the white of the eye), so a cut will need to be made in this to expose the muscles. The tension, position and balance of the muscles will then be altered as appropriate. The surgery is most commonly done with dissolvable stitches. The surgery is often carried out on the squinting eye, but may be done on the other eye (or both eyes) depending on the surgery necessary. This will have been discussed with you at the time of consent The surgery normally takes between 30-60mins although the total time in theatre may be longer because of the anaesthetic time. Normally your child will go home on the same day. Benefits of Surgery To improve the alignment of the eyes in order to make the squint smaller in size and less obvious. Squint Surgery In Children Page 3 of 7

4 In some patients, to reduce, or try to eliminate, double vision or to improve depth (3- D) vision. Occasionally, to improve an abnormal position of the head Surgery does not remove the need to wear glasses, or improve vision. Possible Risks and Complications of Squint Surgery As with any operation, squint surgery carries a risk of complications. The most common complications are as follows: 1. It is possible the squint may not be corrected enough or may be corrected too much and it may turn the other way. 2. Some people need more than one operation to achieve the required result. The Ophthalmologist will discuss this with you. 3. Sometimes people have some double vision. This is almost always temporary, but if persistent further management may be required. 4. There is a small risk of post-operative infection which may require further treatment. 5. There will be a period of postoperative recovery. Any soreness has usually resolved by around a week. The redness can last several weeks. Children are almost always well enough to return to school days after surgery. 6. Uncommonly, the dissolvable stitches can become inflamed and cause a lump to form. This will require further treatment. 7. All eye surgery carries a very small risk of making the situation worse, or damaging the sight in the eye. This may require urgent further surgery. This is most unlikely but must be taken into account when considering an operation. 8. The redness can take up to 3 months to go away. Occasionally the redness does not completely go away, particularly after multiple operations. 9. Scarring is usually not noticeable after 3 months, but can occasionally persist, particularly if there has been more than 1 operation. 10. It is possible that an operated muscle could slip from it s new position. This could need further surgery and may not be able to be corrected. This is rare and has never happened in this department. 11. If you are concerned about any of these complications, please discuss this with the surgeon, prior to surgery. After surgery Your child will be very drowsy and may wish to sleep for some time. Your child s eyes may feel quite sore and they may find it uncomfortable to open their eyes. The white of the eye will be red and there may be some bloodstained tears at first. Try to discourage your child from rubbing their eyes. When your child is awake they will be given something to eat and drink The nurse or doctor will re-assess your child prior to discharge. Before leaving the hospital You will be given eye drops to put into the eye at home. Squint Surgery In Children Page 4 of 7

5 The eye lids do tend to become sticky and crusted around the lashes, in this case they will need bathing. You should use boiled water, which has cooled. It is advisable to make a fresh supply each day, discarding any left from the previous day. Use a clean piece of cotton wool for each eye. It is normal to see a few blood stained tears. It may be helpful to bring with you a pair of sunglasses for your child, especially in the summer so that their eye/s are not affected by bright sunlight when you leave the hospital building A follow up appointment will be made for your child at four weeks after the surgery. At this appointment the orthoptist will measure the squint and the doctor will check the healing of the eye Once at home Your child may eat and drink as normal Initially your child may be tired and irritable, or may sleep for long periods of time but this is normal. It is advisable for your child to rest for the next 24 hours. There is no harm in your child watching television and playing on the computer, however they may complain of blurred or double vision initially. This should settle down in the first few days. If your child is still suffering from double vision please contact the Orthoptic Department for advice. Pain relief Your child may experience some discomfort during the first few days following the operation. This can be relieved by giving Paracetamol paediatric syrup. Always follow the instructions on the bottle as it can be dangerous to exceed the prescribed dose. After care It is often necessary to gently cleanse the eyelids during the first few days. You should use boiled water, which has cooled. It is advisable to make a fresh supply each day, discarding any left from the previous day. Use a clean piece of cotton wool for each eye. Any stitches present are usually dissolvable. These can take a few weeks to dissolve completely. If your child normally wears glasses, encourage them to wear them as soon as possible after surgery If your child normally wears a patch you should not re-start this until after your first appointment with the orthoptist from the completion of the surgery. Squint Surgery In Children Page 5 of 7

6 Your child can normally go back to school after one to two weeks, If your child is not well enough after two weeks please contact your GP For the first six weeks your child should not play in the sand, go swimming, use any face paints or do any contact sports. Contact information If at any point you have any further questions or you are concerned about your child please do not hesitate to contact the Orthoptic Department on between 9am 4pm (out of hours answer machine available) or Rainbow Ward on Orthoptic Department Entrance B Second Floor Wigan Health Centre Frog Lane Wigan WN6 7LB Rainbow Ward Royal Albert Edward Infirmary Wigan Lane Wigan WN1 2NN Squint Surgery In Children Page 6 of 7

7 Comments, Compliments or Complaints The Patient Relations/Patient Advice and Liaison Service (PALS) Department provides confidential on the spot advice, information and support to patients, relatives, friends and carers. Contact Us Tel: (Monday to Friday 9am to 4pm) The Patient Relations/PALS Manager Wrightington, Wigan and Leigh NHS Foundation Trust Royal Albert Edward Infirmary Wigan Lane Wigan WN1 2NN Ask 3 Questions Become more involved in decisions about your healthcare. You may be asked to make choices about your treatment. To begin with, try to make sure you get the answers to three key questions: 1. What are my options? 2. What are the pros and cons of each option for me? 3. How do I get support to help me make a decision that is right for me? This leaflet is also available in audio, large print, Braille and other languages upon request. For more information call Wrightington, Wigan and Leigh NHS Foundation Trust All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner Squint Surgery In Children Page 7 of 7

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