Open Posterior Cervical Decompression

The case

Six small muscles move each eye, and they normally work together so both eyes point at the same thing. In strabismus the eyes do not line up: one may turn in (crossed eyes), out (wall eyes), up or down. It is most often seen in babies and young children. A child's brain can start to ignore the image from the turned eye, and that eye can lose vision for good (amblyopia, or lazy eye), so treatment matters. Glasses, patching, exercises or injections are tried first.

When these do not straighten the eyes, surgery adjusts the muscles. In a recession, a muscle is detached and sewn back farther back on the eye, which weakens its pull. In a resection, a piece of a muscle is removed and the shorter muscle is sewn back where it was, which strengthens its pull. Often one muscle is recessed and its partner is resected. The surgeon reaches the muscles through a small opening in the clear skin over the white of the eye, so there is no cut on the face. In adults, adjustable stitches can let the surgeon fine-tune the position the next day.

Children have general anesthesia, and adults sometimes have a numbing injection as well. Most patients go home the same day. Usually no patch or only a light one is needed. Perfect alignment cannot always be reached, and the muscles sometimes need adjusting again.