Doctor, Why Are You Operating on my Good Eye?

Abstract

Introduction: This paper describes a series of five patients with reduced vision in one eye preoperatively who had bilateral strabismus surgery and developed a visually threatening or actually visually destructive complication in the better seeing eye related to the strabismus surgery. Two complications were from retinal detachments, one from optic atrophy from a retro bulbar hemorrhage, and one from crystalline keratopathy from postoperative use of Ciloxan in the better seeing eye. Methods: A questionnaire was sent by mail to all members of AAPOS and the literature was surveyed. Results: Five patients were identified who had visually threatening or actual vision loss to the better seeing eye following bilateral strabismus surgery. Three of the complications did not involve the use of the scleral bite to reinsert the muscle, illustrating the diverse types of complications that can occur with strabismus surgery. The worst complication in a patient with retrobulbar hemorrhage (resulting in NLP vision) occurred with a superior oblique tenectomy with no suture in the tendon at all. Discussion: The decision of whether to perform strabismus surgery on the better seeing eye occurs frequently in a wide variety of problems, including torticollis, pattern strabismus, and restrictive strabismus. Conclusions: Textbooks and the ophthalmic literature as well as resident education do not directly address the question of when to perform bilateral strabismus surgery in patients with reduced vision in one eye. More concise recommendations from AAPOS would be helpful in guiding pediatric ophthalmologists and in defense of litigation.