Thanks very much for your enquiry. Generally speaking, I would advise LASIK before any squint/strabismus surgery. This is because there is a risk that changing the spectacle power of the eye (via LASIK) may make the intermittent exotropia more obvious if a patient finds it harder to ‘fuse ‘ the images from each eye after LASIK. If so, the strabismus surgery can then address the full effect and magnitude of the squint. Ideally, if strabismus surgery is required, it would be performed at least a month after LASIK surgery when the vision and spectacle power has usually stabilized.
If trial disposable contact lenses are available, these can be worn for a short time to simulate the effect of LASIK. If the squint is not too bad, and does not get worse with a contact lens trial, it is also possible that the squint surgery might not be needed after all.
The risk specific to your particular situation is that LASIK may make the squint worse, and that doing LASIK after squint surgery may make the squint reappear or otherwise compromise the outcome of the prior squint surgery.
To recap,
1) To gauge the risk imposed by LASIK of making the squint worse, a contact lens trial can be helpful. (You may already know this if you usually wear contact lenses-ie if contact lenses don’t affect the squint at all, it is unlikely that LASIK would)
2) To minimise the risk of LASIK causing an adverse outcome on a squint op, it would be better to have LASIK first, before any planned squint surgery.
