Anaesthetic considerations for strabismus surgery in children and adults

Abstract

Strabismus correction surgery is the most common eye operation in children. Adults have approximately a 4% lifetime risk of developing strabismus. Current treatment options include pharmacological injection of botulinum toxin or bupivacaine, conventional corrective surgery, adjustable suture surgery and minimally invasive surgery. Repeated surgery is common as each operation has a 60%–80% chance of successful correction. The benefits of early surgical correction in large-angle strabismus in children outweigh the risks of anaesthesia. General anaesthesia is suitable for patients of all age groups, for complicated or repeated surgery, and bilateral eye procedures. Regional ophthalmic block reduces the incidence of oculocardiac reflex and emergence agitation, and provides postoperative analgesia, but requires a cooperative patient as many experience discomfort. Topical anaesthesia has been used in pharmacological injection, minimally invasive surgery, uncomplicated conventional strabismus surgery and some adjustable suture strabismus surgery. Its use, however, is only limited to cooperative adult patients. Prophylactic antiemesis with both ondansetron and dexamethasone is recommended, especially for children. A multimodal analgesia approach, including paracetamol, intravenous non-steroidal anti-inflammatory drugs, topical local anaesthetic and minimal opioid usage, is recommended for postoperative analgesia, while a supplementary regional ophthalmic block is at the discretion of the team.

The Effect of Different Anesthesia Techniques on Strabismus Surgery: A Prospective Observational Study

“…Many factors influence the degree of deviation in the postoperative period, including age, refractive problems, decreased visual acuity, type and duration of strabismus, preoperative deviation angles, surgeon experience, and how the suture is passed through the sclera (9,10,11). Although most strabismus surgeries are operated under general anesthesia, eligible and compatible adult patients can be operated on with local or topical anesthetic (2,12). Because all the patients in our study were children (aged between 2 and 14), they were all operated on under general anesthesia by the same surgeon using the same procedure.…”

“…Children with strabismus account for 3-5% of all children, with correction surgeries the most prevalent among eye operations (1). Most pediatric ophthalmic procedures are done under general anesthesia (2).…”

“…Different anesthetic procedures may produce varying degrees of muscle tone loss during the application of anesthesia, resulting in inaccurate surgical correction results. The systemic effects of various anesthetic procedures in strabismus surgery have been mainly studied in patients in the literature so far (1,2,4). However, there is limited research on the outcomes of anesthetic procedures in strabismus surgery (5,6).…”

Reply to: Intellectual impairment is not commonly a feature of Turner syndrome

“…1 With limited space and word restriction, these were ‘loosely’ grouped under our heading of ‘intellectual impairment’ in Table 2 of our review. 2…”

“…1 With limited space and word restriction, these were 'loosely' grouped under our heading of 'intellectual impairment' in Table 2 of our review. 2 The focus of our review article was on anaesthetic considerations for strabismus surgery. The purpose of the table on the syndromes was to provide readers with some information on each of the strabismus-associated syndromes, as some of these syndromes are rare.…”