Amblyopia Surgery: Everything You Need to Know

In This Article

Amblyopia surgery is one of the strategies used for alleviating symptoms of amblyopia, better known as lazy eye. These can include unequal vision in the eyes and impaired depth perception. Generally, non-surgical interventions are more common than surgery for managing the effects of amblyopia. But when appropriate, a range of different surgical procedures can be used to treat the condition. The right one for you or your child depends on the cause of lazy eye, be it strabismus (crossed eyes), structural eye defects, cataracts, or eye trauma.

lazy eye treatment
Verywell / Brianna Gilmartin

What Is Amblyopia Surgery?

Amblyopia surgery includes a variety of distinct procedures that are aimed at correcting vision impairment that's worse in one eye than the other. Several different anatomical issues can cause amblyopia, and there are a variety of surgical techniques used to treat it because of this:

  • Refractive correction: Sometimes, a refractive vision impairment such as myopia (nearsightedness), hyperopia (farsightedness), or astigmatism can cause amblyopia. This can happen if the vision defect affects only one eye or if it affects both eyes unequally. Surgical vision correction might reverse amblyopia, especially if the surgery is done at a young age.
  • Eye muscle surgery: This operation involves surgically restructuring uneven eye muscles. It is usually done for strabismus with or without vision problems. This surgery can also be used to correct amblyopia that's caused by strabismus.
  • Cataract surgery: Cataracts can lead to amblyopia due to clouded vision in one eye. Amblyopia may be resolved with surgical treatment of the cataract.
  • Relieving pressure in the eye: A structural problem, like a tumor, blood, fluid, or inflammation can cause pressure in the eye that may lead to symptoms of amblyopia. Repairing the problem can alleviate amblyopia.

It's possible that more than one procedure might be needed to correct amblyopia, and these may have to be scheduled independently.

These procedures are considered amblyopia surgeries not because they are specifically aimed at addressing the condition, but rather because they correct amblyopia by fixing the underlying problem causing it.

Amblyopia procedures are usually minimally invasive with a small incision, and some are done with laser surgery. General anesthesia or monitored anesthesia sedation with local anesthesia are required for pain control.

Contraindications

While useful for theses eye issues, surgery is not useful for all types of vision defects that cause amblyopia. For example, if the visual defect is caused by dysfunction of the brain's occipital lobe (the primary vision area), surgery will not correct it.

Health issues like a bleeding disorder, inflammatory disease, or immune dysfunction can increase your risk of complications, so you and your doctor will have to weigh the risks and benefits of surgery in your case.

An acute illness or infection can be a contraindication to amblyopia surgery and will need to resolve before the procedure can proceed.

Potential Risks

In addition to the standard risks associated with surgery and anesthesia, surgery for amblyopia treatment has certain potential complications.

Problems that may occur due to the surgery include:

  • Bleeding
  • Structural damage to the eye
  • Swelling
  • Infection

These complications might require immediate intervention. If not adequately resolved, an adverse surgical event may result in a lasting vision issue that could be worse than the original problem.

Blurred vision due to unequal eye movement can occur as a result of adverse surgical events; decreased vision or blindness due to this surgery is a very rare possibility.

Incomplete correction or overcorrection of the structural issue is possible as well and may cause lasting vision and/or eye movement defects.

Purpose of Amblyopia Surgery

Amblyopia is the leading cause of vision loss in children. Surgery is often done during early childhood, and it can correct congenital defects. Sometimes amblyopia can develop later in childhood or adulthood, and amblyopia surgery might be considered if the structural issue is surgically repairable.

Surgery can prevent vision loss and can also relieve the following effects of amblyopia:

  • Decreased vision in one or both eyes
  • Misaligned eyes (one eye turned inward)
  • Head tilting
  • Squinting
  • Impaired depth perception      

The effects of amblyopia are not always obvious. In fact, many people with amblyopia do not complain about vision difficulties or eye movement issues. Often, amblyopia is diagnosed with a routine eye examination, such as a refraction test.

The American Academy of Ophthalmology suggests that children should have their eyes examined and vision tested as newborns, before age 1, and again before age 3.

Addressing amblyopia as early as possible is important. Vision deficits in amblyopia can occur due to several mechanisms that change the way the brain processes visual information:

  • When vision is better in one eye, the brain may adapt and preferentially use the better eye, ignoring the eye with impaired vision. When one eye is not used, vision declines further and eye movement is impaired.
  • Misaligned eye movements cause blurred or double vision. The brain suppresses one of the images by favoring one eye. This causes the vision to decline in the other eye.

These changes alter the visual function in the brain, and once that occurs, surgical repair is not possible.

Patching is a common treatment for amblyopia. Wearing a patch over the good eye forces the brain to start using the weaker eye so it can become stronger. As an alternative, prescription eye drops are sometimes used to blur the vision in the stronger eye for the same purpose.

Eyeglasses are used for temporary correction of refractive errors. Sometimes, a lens prescription eventually leads to normal vision.

If non-surgical treatment is not effective, surgery may be considered for the correction of amblyopia.

Surgery at a young age is generally more effective when it comes to preventing vision loss, which is why a procedure might be considered if amblyopia is detected with a vision screening test—even if symptoms have not yet begun.

How to Prepare

The ophthalmologist (eye surgeon) will plan the procedure based on observation of the eyes with an eye examination, eye muscle testing, and imaging tests such as a computerized tomography (CT) scan.

Specific testing might be needed to evaluate issues like congenital cataracts.

You and your doctor will discuss the necessary correction, as well as whether the surgery will be done with a laser. There are several types of laser eye surgeries, such as laser surgery for cataracts. Laser-assisted in situ keratomileuses (LASIK) is used to correct refractive issues. A laser approach might or might not be right best.

Additionally, pre-operative testing includes anesthesia preparation. This can include a chest X-ray, electrocardiogram (EKG), complete blood count (CBC), and blood chemistry tests.

Location

The surgery will take place in a hospital or surgical center operating room, or an eye surgery suite.

Amblyopia surgery is generally an outpatient procedure, meaning you will go home on the same day.

What to Wear

You or your child can wear anything comfortable for the procedure appointment. Eye makeup (or makeup around the eyes) should be avoided, and any hair that can get in or near the eyes should be pinned back and free of styling products.

Food and Drink

Depending on the type of anesthesia be used, there might be restrictions in terms of food and drink.

For example, with general anesthesia, eating and drinking must cease at midnight the day before the surgery. And if your very young child is having this surgery with general anesthesia, the timing for abstaining from food and drink might be adjusted (usually to a shorter duration of fasting).

The surgical or anesthesia team will provide specific instructions.

Medications

Typically, blood thinners and anti-inflammatory medications must be stopped for several days before this surgery.

Additionally, use of lubricating eye drops or antibiotic ointment may be needed for several days before the surgery. You may also be given a prescription for other medications, such as steroids or a diuretic if there is swelling or inflammation in the brain or eye.

What to Bring

On the day of surgery, you need to bring a form of identification, insurance information, and a method of payment for any portion of the surgery you will be responsible for paying.

If you are having surgery as an adult, someone must be available to drive you home on the day of the procedure.

Children might be allowed to bring a small comfort item to the pre-operative surgical area on the day of surgery.

Pre-Op Lifestyle Changes

Before your surgery, you or your child might be instructed to wear an eye patch on the stronger eye. This can prevent eye muscle weakness or diminished vision from worsening in your weaker eye.

What to Expect on the Day of Surgery

When you arrive at the surgery appointment, you will need to register and sign a consent form. You will be asked to show identification and insurance information.

If your child is having the eye operation, you may be permitted to go with them to the pre-operative area. Same day testing may include CBC, electrolyte tests, and a urine test. If an infection is detected, the surgery may need to be rescheduled.

Vital signs, including temperature, blood pressure, pulse, and breathing rate will be monitored. Typically, oxygen saturation with a pulse oximeter will be checked as well.

An intravenous (IV, in a vein) line will be placed in the arm or hand. The ophthalmologist and anesthesiologist may come to do a pre-operative check shortly before surgery.

Then, when it is time for surgery, you will go to the operating room or procedure suite.

Before the Surgery

Preparation includes getting the eye ready for an incision and administering anesthesia.

  • With general anesthesia, anesthetic medication is injected through the IV or inhaled through a mask. This medication induces sleep and inhibits pain and muscle movement. A breathing tube is inserted into the throat for mechanical breathing during surgery.
  • For IV sedation, anesthetic medication is injected into the IV, inhaled through a mask, or taken by mouth to induce drowsiness. Then local anesthetic medication is injected in the eye with a tiny needle or as eye drops.

Sometimes, antibiotic ointment is applied to the eye prior to surgery.

During the Surgery

A small retractor will be used to gently hold the eye open. It will remain this way throughout the surgery, but the anesthesia will prevent any discomfort.

A small incision is generally made in the cornea, which is the thin covering over the eye. Typically, the incision is made to the side of the pupil, in the conjunctiva (the white part of the eye). The surgeon may use a scalpel or a laser device for this.

After the initial incision is made, the doctor will locate the structural area or areas of the eye that need to be operated on. The surgical repairs may be done with a laser or with very small surgical tools.

Specific corrective techniques can include:

  • Restructuring eye muscles
  • Phacoemulsification to remove a cataract
  • Replacing the lens in the eye
  • Keratomileusis (reshaping the cornea)
  • Removing a tumor or growth

Bleeding will be controlled throughout the surgery. Sometimes sutures are placed to hold structures in the intended position. After the corrections are complete, cuts that were made may be repaired with suture as well.

After the surgery is done, the eye might be covered with bandages for protection and to prevent contamination.

Anesthesia will be stopped or reversed and, if general anesthesia was used, the breathing tube will be removed. The anesthesia team will ensure that you or your child are breathing independently before releasing you to the recovery area.

After the Surgery

While waiting for the anesthesia to wear off, vital signs and oxygen levels will be monitored. Pain medication will be given as needed.

Use of the bathroom without assistance will be permitted, and the nurse will ensure that small amounts of food and drink are tolerated.

If they are and no complications occur, then you should be discharged to go home within a few hours after the procedure. You will get instructions about activity restrictions, eye care, who to call if complications arise, and necessary follow-up appointments. A prescription for pain medication and possibly an antibiotic will also be written.

Recovery

Recovery after amblyopia surgery and necessary eye care during this time varies and depends on the specific procedure that was done.

For example, it is important to avoid looking at the sun or at bright lights for a few weeks after some types of laser surgery. Protecting the eye from contamination is important after eye muscle surgery. And you may need to avoid exertion after cataract surgery.

If you are unsure about your recovery period instructions, be sure to call your surgeon's office.

Healing

As you are healing from any type of amblyopia surgery, there are some general considerations to keep in mind.

Keep your eye clean and dry for several weeks after your procedure. Try not to touch your eye and do what you can to prevent dirt, germs, and everyday products (like shampoo) from entering the eye as well.

You might be given a prescription for antibiotics or other medications. Be sure to take them as directed.

You might experience mild pain, discomfort, or swelling for a few days. The pain can usually be managed with over-the-counter pain medication like Tylenol (acetaminophen), and the swelling can be managed with a cold pack.

But if you have more pain or swelling than what you were told to anticipate, you should get in touch with your doctor's office. Also inform your doctor if any signs of complications arise, including:

  • Fever
  • Pain
  • Eye swelling
  • Draining pus
  • Bleeding from the eye
  • Bruising around the eye
  • Vision changes

Coping With Recovery

For at least the first week after surgery, you will need to avoid strenuous activities (like heavy lifting) and active motion (like riding a roller coaster) so your eye can heal. Your doctor will give you a timeline for when you can restart these types of activities.

You should be able to read and look at a computer, but give yourself some rest so you won't get exhausted or experience headaches.

You may need to wear an eye patch on your surgical eye for a few weeks after surgery to prevent contamination and infection.

Excessive sunlight or bright lights can interfere with healing, so you will need to wear sunglasses to protect your eyes from excessive light after you stop wearing a patch.

Sometimes, physical therapy is needed for your eyes. This can include eye movement exercises to strengthen weakened muscles.

Long-Term Care and Vision

Generally, after surgery that's done to correct amblyopia and recovery is complete, you should experience an improvement in your vision. You shouldn't have to adopt any long-term lifestyle limitations, and you might have fewer limitations than before the surgery if your pre-surgical vision deficit interfered with your ability to participate in certain activities, such as sports.

That said, you might still have some vision defects after surgery. Your vision might be different than it was before as well. Your doctor might give you a new prescription for eyeglasses several weeks or months after you heal.

After surgery to correct amblyopia, you will need to have regular eye examinations. If you have a condition that affects your eye health, you might continue to have long-term treatment for that condition.

After any type of eye surgery, dry eyes can be a problem. Using eye drops for lubrication and wearing sunglasses in bright light can help prevent this problem.

Possible Future Surgeries

If you have a severe complication, like excessive bleeding or damage to your eye, you could have emergency surgery to alleviate that problem.

And you might need future surgery if you develop another surgically correctable eye problem at a later date.

If your amblyopia surgery is part of a plan that includes several separate surgical procedures, you will need to have the next surgery at some point.

A Word From Verywell

Surgical treatment for amblyopia includes a variety of methods that aim to correct unequal vision. If you or your child has been diagnosed with amblyopia, surgery isn't likely to be the first therapeutic step. But surgery for treating amblyopia is considered safe, and the outcome can improve quality of life.

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Article Sources
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