[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Ophthalmology](https://durgical.com/en/ophthalmology/) › [Eye surgery and procedures](https://durgical.com/en/ophthalmology/areas/surgery/) › Strabismus surgery: what it does and what follows # Strabismus surgery: what it does and what follows - Topic Squint surgery moves or tightens eye muscles to straighten the eyes. It aligns the eyes but does not cure amblyopia: glasses and patching still matter. Updated Nov 13, 2026 **See it in 3D:** [Medial rectus](https://durgical.com/en/anatomy/medial-rectus-muscle/) · [Lateral rectus](https://durgical.com/en/anatomy/lateral-rectus-muscle/) · [Superior oblique](https://durgical.com/en/anatomy/superior-oblique-muscle/) · [Inferior oblique](https://durgical.com/en/anatomy/inferior-oblique-muscle/) ## Key points - Recession weakens; resection strengthens. - Glasses and amblyopia treatment come first. - Accommodative esotropia: glasses, not surgery. - Muscle traction can cause bradycardia (oculocardiac reflex). - Paralytic squint: operate only when stable. ## What it is Strabismus surgery changes the pull of the extraocular muscles. A recession moves a muscle's insertion back to weaken it; a resection or plication shortens a muscle to strengthen it; a transposition moves healthy muscles to take over from a paralysed one. Children are operated under general anaesthesia; adults may have adjustable sutures fine-tuned after surgery. Botulinum toxin injection into a muscle is an alternative in selected cases. Goals are alignment, binocular vision, relief of double vision and a normal head posture. ## Key facts - Correct the refractive error and treat amblyopia first; surgery straightens the eyes but does not restore vision in a lazy eye. - Accommodative esotropia is treated with full hyperopic glasses, not surgery. - Infantile esotropia is usually operated early in childhood to give the best chance of some binocular vision. - Paralytic squints (sixth nerve palsy, thyroid eye disease) are operated only after the deviation has been stable for months. - In adults, surgery relieves double vision and head turn and has real psychosocial benefit; it is not merely cosmetic. - Some patients need more than one operation. ## In clinical practice - Traction on an eye muscle can trigger the oculocardiac reflex: sudden bradycardia or asystole during surgery, reversed by releasing traction and giving atropine. - After surgery the eye is red and gritty for some weeks and brief double vision is common. - Rare but serious: infection (orbital cellulitis, endophthalmitis after scleral perforation) and a slipped or lost muscle. - A new squint or double vision in an adult needs a cause before surgery: nerve palsy, thyroid eye disease, myasthenia or a mass. ## Next step / Initial management - Child with a squint: refer to paediatric ophthalmology for cycloplegic refraction, amblyopia treatment and surgery if still needed. - New squint or diplopia in an adult: look for the cause (neuroimaging when indicated, thyroid tests, myasthenia work-up) before surgery is discussed. - After surgery: increasing pain, lid swelling, fever, discharge or a fall in vision needs same-day ophthalmology. - Sudden loss of movement of the operated eye: urgent review (slipped or lost muscle). - Keep glasses and patching going after surgery as prescribed. ## Test yourself Think of the answer, then tap the question to see it. ## What is the difference between a muscle recession and a resection? A recession moves the insertion back and weakens the muscle; a resection shortens it and strengthens it. ## During squint surgery, the heart rate suddenly falls as the surgeon pulls on a muscle. What is happening and what is done? The oculocardiac reflex; traction is released and atropine is given if needed. ## What is the first-line treatment of accommodative esotropia? Full correction of the hyperopia with glasses. ## Why is surgery for a sixth nerve palsy delayed? Many palsies recover, and surgery is planned only once the deviation is stable. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/ophthalmology/strabismus-surgery-what-it-does-and-what-follows/) ## Connections ## See it in 3D 4 The structures of Durgical's 3D anatomy where it is found. - [Medial rectus](https://durgical.com/en/anatomy/medial-rectus-muscle/) - [Lateral rectus](https://durgical.com/en/anatomy/lateral-rectus-muscle/) - [Superior oblique](https://durgical.com/en/anatomy/superior-oblique-muscle/) - [Inferior oblique](https://durgical.com/en/anatomy/inferior-oblique-muscle/) ## Related 5 - [Strabismus in children: esotropia, exotropia, pseudostrabismus](https://durgical.com/en/ophthalmology/strabismus-in-children-esotropia-exotropia-pseudostrabismus/) - [Amblyopia: the critical period, patching and atropine](https://durgical.com/en/ophthalmology/amblyopia-the-critical-period-patching-and-atropine/) - [Eye movements and the cover test](https://durgical.com/en/ophthalmology/eye-movements-and-the-cover-test/) - [Extraocular muscles and the cardinal positions of gaze](https://durgical.com/en/ophthalmology/extraocular-muscles-and-the-cardinal-positions-of-gaze/) - [Double vision: monocular or binocular](https://durgical.com/en/ophthalmology/double-vision-monocular-or-binocular/) ## Related conditions 5 - [Strabismus and amblyopia](https://durgical.com/en/conditions/strabismus-and-amblyopia/) - [Abducens (sixth) nerve palsy](https://durgical.com/en/conditions/abducens-nerve-palsy/) - [Trochlear (fourth) nerve palsy](https://durgical.com/en/conditions/trochlear-nerve-palsy/) - [Thyroid eye disease (Graves orbitopathy)](https://durgical.com/en/conditions/thyroid-eye-disease/) - [Myasthenia gravis](https://durgical.com/en/conditions/myasthenia-gravis/) ## In Pharmacology 1 - [Atropine](https://durgical.com/en/pharmacology/atropine/) [← All of ophthalmology](https://durgical.com/en/ophthalmology/) Educational content; not a clinical guideline and no substitute for assessment by a health professional. For sudden visual loss, severe eye pain, a chemical burn or an eye injury, go to an emergency department at once. Sources: [Strabismus](https://www.ncbi.nlm.nih.gov/books/NBK560782/) (StatPearls Publishing (NCBI Bookshelf), 2026); [Esotropia](https://www.ncbi.nlm.nih.gov/books/NBK578207/) (StatPearls Publishing (NCBI Bookshelf), 2023); [Exotropia](https://www.ncbi.nlm.nih.gov/books/NBK578185/) (StatPearls Publishing (NCBI Bookshelf), 2023). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/ophthalmology/strabismus-surgery-what-it-does-and-what-follows/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/ophthalmology/strabismus-surgery-what-it-does-and-what-follows/