Complications of Surgery

What are the common minor complications and the rare but serious complications that can occur during or after squint surgery.

Video Transcript:

Fortunately, serious complications following squint surgery are rare, these include:

1. Slipped muscles
A slipped muscle occurs when the stitches holding the eye muscle to the outer coat of the eyeball break or loosen and the muscle moves backwards to a position behind the eyeball. This rare complication (approximately 1 in 400 cases) can occur during, or in the first week after the operation. If it occurs after the operation the patient / parents will notice that the eye position has suddenly changed and that they / their child cannot move the eye in one particular direction. They may also be aware of double vision. Further surgery to find the slipped muscle and stitch it securely to the sclera is required within 24 hours. Very occasionally it is not possible to find the slipped muscle (this is then called a lost muscle) and a different type of operation is needed to try and improve the alignment of the eyes.

A slipped muscle is more likely to occur during, or after redo surgery.

2. Scleral perforation
This refers to the penetration of the outer coat of the eyeball with a surgical needle. The incidence of this complication is thought to be in the region of 1-2% of cases. Scleral perforations in children often require no treatment. A scleral perforation in an adult is usually treated by applying a “freezing” probe to the site of the perforation, to minimise the risk of developing a retinal detachment. A course of antibiotics may also be prescribed to minimize the risk of an infection developing in the eye. Perforations are more likely to occur in the following situations:

• - Redo surgery
• - Posterior fixation suture surgery
• - In patients who are very short sighted (their sclera tends to be thinner than normal sighted people)

3. The risk of an infection developing in the eye (endophthalmitis), which could permanently damage the vision in the eye, is 1 in 20,000 cases.

• - The risk of developing an infection in the eyelids and in the eye socket (orbit) which would require treatment with intravenous antibiotics is 1 in 2000 cases.
• - Surgically Induced Necrotising Scleritis (SINS) is a rare complication of ocular surgery in adults that results in marked inflammation of the sclera. Treatment with steroid tablets and other immunosuppressant medication is needed to control this inflammation.

A recent year long survey of all the ophthalmologists in the UK found that the chance of one of these complications resulting in reduced vision or untreatable double vision was 1 in 2500 cases.

Minor complications following squint surgery include:

• - Conjunctivitis, is usually short lived and improves with a course of antibiotic drops.
• - A Suture granuloma is an area of inflammation around one of the stitches in the eye muscles, before it has dissolved completely.

A short course of steroid drops will usually settle this down.