Pediatric Strabismus Surgery

Pediatric Strabismus

Children that have strabismus can learn to ignore the image from the misaligned eye. Still, in certain circumstances, Dr. Hill will recommend surgery to fix the eye muscles and straighten out the eyeballs. Please contact our office if you have more questions.

Pediatric strabismus surgery is usually done under general anesthetic at the Alberta Children's Hospital. Traditional microsurgical instruments are used. There is no current role for lasers in this type of surgery. A small incision is made in the conjunctiva (clear surface skin of the eye), and the muscle is accessed. The muscle is then detached from its original insertion and repositioned to its new location with sutures. These sutures are secured midway onto the eye's outer wall and do not routinely penetrate the eyeball cavity itself.

Most surgeries done at the Alberta Children's Hospital are day surgeries, which means your child will get to go home that night. However, in some cases, you may be asked to stay overnight for observation.

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Pediatric Strabismus

What Are The Risks Involved?

As with any other surgery, there are some risks associated with strabismus surgery. Serious complications resulting from this surgery are rare, but you may speak with your ophthalmologist if you have any concerns. Some risks that have been reported with strabismus surgery are:

  • Over/under correction resulting in a possible second procedure, there is a less than ten percent chance of this occurring. Perfect alignment is not always achievable and may not always be the goal.
  • Infections: You can manage minor infections with some extra eye drops. Serious infections are rare (1/10000) but could result in loss of vision or eye loss.
  • Small lumps, cysts, or persistent redness have been reported and are more common if you have had previous surgery. The redness will last longer if you have thyroid eye disease.
  • Eyeball perforations with the suture are very rare. If they occur, it is usually insignificant, but you may require laser surgery to seal the hole or treat a resulting hemorrhage.
  • A slipped or lost muscle is rare but would require a prompt second surgery or a prolonged intraoperative course.
  • Serious reactions to the anesthetic are extremely rare. They can include cardiac arrest, death, or other bodily injuries.

Your surgeon uses pre-operative measurements (orthoptics) to calculate the amount of repositioning required and which eye(s) should be operated on for the best possible results.

Pre-operative Instructions For Pediatric Strabismus In The Weeks Before Surgery

The Pre-Admission Clinic (PAC) staff will phone you 1-2 weeks before the surgery to go over your child's health history, give you instructions on getting your child ready for surgery, and answer any questions you may have.

Do not give your child medicine with aspirin in it (like ASA, Aspirin, or Asaphen) or ibuprofen (like Motrin or Advil) 10 days before surgery. Please call PAC at 403-955-7953 if you have any questions.

Plan to have your other children stay with family or a friend on the day of the surgery, as it can be a very long day for them. If this is not possible, Emily's Backyard offers free childcare on the hospital's main level. Space is limited, so please call 403-955-2500 or email eby@calgaryhealthregion.ca to book ahead.

We ask that at least one parent is with your child on the day of surgery. If your child is staying overnight, one parent is welcome to stay at the bedside. Your surgeon will tell you how long your child will need to stay home to recover. This will help you plan for days off work.

Special Information

If, for any reason, you need to cancel or postpone your child's surgery, please call surgical booking at 403-245-3171. If it is within 24 hours of the surgery, you will also need to call the Short Stay Surgical Unit at 403-955-7856.

For health situations, non-English speaking patients need to use a certified healthcare interpreter. If you need a certified healthcare interpreter for the day of surgery, ask your surgeon's office to call 403-955-1199 to arrange for an interpreter. You can also call the Pre-Admission Clinic at 403-955-7953.

If a yellow band is put on your child's wrist after blood work is done, please do not take it off. If it is taken off, your child will need to have another blood sample taken before surgery.

The Day Before Surgery

Please call the hospital the day before your child's surgery to find out what time you should be at the hospital. Please call 403-955-7856 between 1:00 PM and 3:00 PM. If your child's surgery is on a Monday or Monday is a holiday, please call the Friday before. We ask that you arrive on time. This gives the nurses enough time to get your child ready for surgery and work around any schedule changes.

Instructions About Eating & Drinking

When you call the hospital, you will also be told when your child needs to stop eating or drinking before the surgery. You must follow these instructions carefully. Your child's stomach needs to empty before he or she is given anesthesia (sleep medication). Your child cannot have gum or candy on the day of surgery either. If your child has something to eat or drink by mistake, the surgery may have to be delayed or cancelled.

If Your Child Becomes Sick

If your child has a fever, cough, or flu symptoms within 1-2 days of surgery, please call your surgeon. If your child is sick within 24 hours of the surgery, please call the Short Stay Surgical Unit at 403-955-7856 to speak to a nurse. If you reach our answering machine, please leave a message.

You may still be asked to come in on the day of surgery. The doctor who gives your child the anesthesia will check your child and decide if the surgery should be postponed until your child feels better.

Bath/Shower

Have your child take a bath or shower, including washing their hair the night before or the morning of surgery. Braid long hair or tie it back in a ponytail so it is out of the way. Use only plain elastics (no metal clips). Your child will also need to take off all make-up, nail polish, and jewelry (including body piercings) before coming to the hospital.

Medication

The PAC staff will tell you what time to give your child any prescription medication(s) on the day of surgery. If you have questions about medications, please call 403-955-7856 to speak to a nurse. Let us know if your child is stopping or starting any new medication before surgery.

Parking & Checking In

There is lots of parking in the parkade, which is near the hospital's main entrance. A heated walkway connects the parkade to the hospital. There is disabled parking on each level of the parkade and in both of the outdoor parking lots. The outdoor lots are near the Emergency and Rehabilitation entrances.

Please go to the Admitting desk near the main entrance to check-in.

What To Bring To The Hospital

  • Loose, comfortable clothes for your child to wear home.
  • Warm socks/slippers and a zip-up hoodie/housecoat to wear with the hospital pyjamas. A comfort item for your child to take into the operating room (toy, blanket, or stuffed animal).
  • Any special medications, including inhalers, insulin, or heart or seizure medications.
  • Any special medical supplies needed for things like G-tube feedings, trach care, or diabetes.
  • Toys, books, or handheld electronic games, DVD movies, and portable music players.
  • Any special bottle, nipple, or sippy cup your child likes so that they can use it after surgery.
  • Your child's Alberta Health Care card.

Pack your child's things in a small suitcase or backpack. Please put your child's name on all of his or her belongings. Make sure you leave all expensive items and jewelry at home.

When Your Child Goes Home

To help you care for your child at home, you will be given a sheet of written instructions. There will be information on what to watch out for, when to call your surgeon, medication, diet, activity, and/or caring for your child's incision. Before you leave, your nurse will go over these instructions with you. Please ask us about anything that you do not understand.

It is best to have two adults for the drive home, so one person can sit with and take care of your child. If you came by bus, please ask someone you know to drive you home. The staff can also help you arrange for a taxi. It is a good idea to have a container or re-sealable plastic bag with you in case your child feels sick on the way home.

Have pain medicine like Tylenol or Tempra for when your child comes home. We also suggest you have extra fluids, such as soups, popsicles, and juices, at home.

Specialized Care Plans

Would your child benefit from a specialized care plan for surgery? For children with Autism, high anxiety, or other special needs, the day of surgery can be challenging. We would like to help your family develop a plan to prepare for surgery in a way that works best for your child. The hospital can provide you with details about the day, communicate your child's needs to the surgical team, and develop a coping plan for your child. A child life specialist can work with your family and the surgical team to help and support you. Please contact child.life@ahs.ca

Every Tuesday, programs are also offered out of the hospital to learn all about the equipment, anesthesia, and see the surgical areas with your child to answer any questions they may have! It is recommended to do this at least 1-2 weeks before surgery. Contact the email above to register!

Cancellation Of Surgery

You must attend all pre-operative appointments to avoid the possible cancellation of the surgery. The pre-operative appointments allow us to get the pre-operative measurements that are essential for success with strabismus surgery. Suppose you miss your pre-operative appointments and your ophthalmologist does not feel that it is safe to proceed with the surgery. In that case, we may cancel your strabismus surgery.

You must confirm your surgery to avoid cancellation.

If you need to cancel or postpone your surgery, please contact surgical booking as soon as possible at 403-245-3171. This must be done at least one week before surgery, or a $500 rebooking fee will apply. We will make exceptions for emergencies. However, that is up to the discretion of our office.