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What is the effect of LASIK on strabismus (cross-eyed)?

Eye & LASIK

Dear doctors,

I would like to look into getting a LASIK-type treatment for myopia and astigmatism correction, but I also happen to have a condition of adult strabismus (intermittent exotropia). Given this, I was wondering if LASIK is in/advisable before or after a strabismus correction operation, or if the 2 treatments are independent.

If they are not independent (I would not expect them to be!):

  1. Is it possible to do both treatments one after another? If so, in which order, and what would the recommended interval be like?
  2. What are the risks specific to this double treatment to take note of?

Thank you!

DOCTOR’S ANSWER (2)

You are correct to conclude that in order for you to have a satisfactory outcome in the above situation, both the refractive errors and strabismus have to be addressed. Ideally, we should conduct a full evaluation of your eyes to rule out any other eye-related problems.

Generally, refractive surgery should be performed prior to the strabismus surgery as the degree of strabismus may change after refractive surgery. This sequence would result in a more stable and predictable outcome for both conditions. The risk of performing the strabismus surgery first is that the strabismus may re-emerge after the refractive surgery. Strabismus surgery can be performed once the vision following LASIK has stabilised. This would ideally be a minimum period of 1 month.

The main precautions about having to address both these conditions are that a full evaluation of the eyes and strabismus is needed, the strabismus and refractive errors are stable and that there are no contraindications to having both surgeries.

808 views 25 Jan 2018

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.

796 views 25 Jan 2018
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