If other treatments are unsuccessful, surgery may be needed to correct a squint.

Surgery can be used to:

• improve the alignment of the eyes (and therefore their appearance)
• help the eyes work together

The operation

Surgery involves moving the muscles attached to the outside of the eye to a new position. It may be necessary to operate on both eyes to balance them, even if the squint is only in one eye.

The operation is carried out under general anaesthetic and usually takes less than an hour to perform. It's often carried out as a day case, so your child can go home the same day.

You may be able to accompany your child to the operating theatre and stay with them until they've been given the anaesthetic. A nurse will be with your child throughout the procedure.

During the operation, your child's eye will be kept open using an instrument called a lid speculum. The ophthalmologist (eyecare specialist) will detach one part of the muscle connected to your child's eye and will either move it backwards to weaken the pulling effect, or shorten it to increase the pulling effect. Once the correction has been made, the muscles will be sewn back into place using dissolvable stitches.

Risks of surgery

As with any kind of operation, there's a risk of problems after surgery to fix a squint. Ask your ophthalmologist to discuss any possible risks of surgery with you before the operation.

Risks of eye surgery include:

• further surgery being needed – which is sometimes needed if the squint is severe
• the eye remaining red for a long time after the operation – this is rare, but may be caused by scar tissue forming on the surface of the eye
• double vision may occur after the operation – this usually resolves itself after a week or so
• the squint may recur, or the operation may need to be repeated for another reason
• in rare cases, the inside of the eye can be damaged during surgery
• an infection may develop after the operation – this is possible with any type of surgery

One study that looked at squint surgery for adults estimated that around one in five people may need more than one operation to treat their squint successfully. Double vision occurred in less than one in 100 cases. This usually either improves with time, or it can be treated with further surgery, for example.

In children, it's more common to need another operation to correct the squint, particularly if the first operation was carried out when the child was very young. Some studies have found that around six out of 10 children who have squint surgery at about one year of age need to have another operation at some point.

Other complications in children are usually rare, but you should ask your ophthalmologist for more information.

Recovering from surgery

It can take several weeks to fully recover from corrective eye surgery. After surgery, the eye is likely to be sore for a few days. The pain can be treated using simple painkillers, such as paracetamol. Children under 16 years of age shouldn't be given aspirin. If the pain doesn't improve, speak to your eyecare specialist or visit your GP.

Following eye surgery, a pad may be put over the affected eye, which is usually removed before being discharged from hospital. There is no need to wear a patch or bandage at home and you can return to daily activities, such as reading, as soon as you feel able to. The aim is to get the eyes working normally as quickly as possible.

Going home

Your care team can give you more specific advice about returning home after an eye operation, but some general tips include:

• drink water at regular intervals
• the stitches can take up to six weeks to dissolve and it may feel like there's a bit of grit in the eye, or the eye may be itchy – try not to rub it
• avoid washing your hair for a few days and try not to get any soap or shampoo in the eye
• your child shouldn't play in sand or use face paint for two weeks after the operation
• regular follow-up visits with an eyecare specialist will be required
• if glasses were needed before the operation, they will probably still need to be worn

Returning to school or work

Your child should be able to return to school or nursery about a week after surgery. If you've had surgery, you should also be able to return to work after about a week.

Sports

After surgery, avoid playing sports for around two weeks. You may need to avoid contact sports, such as rugby, for up to a month. Swimming should be avoided for at least a month after the operation.

Driving

If you've had surgery to correct a squint and you drive, ask your surgeon when you can drive again. You shouldn't drive if you have double vision.