1. Do I need surgery?

2. Is there another option instead of surgery?

3. How long have you been in practice in this field?

4. Do you, yourself, do the surgery?

5. How many of these kinds of surgeries have you performed?

6. What specifically do you do during the surgery?

7. Do you operate on both eyes, or one then another at a later date?

8. What are the chances that there will be more of a problem following the surgery than before the surgery?

9. What is the percentage of success for this surgery?

10. What is the percentage of success that you have had with this surgery?

11. What contributes to an unsuccessful surgery?

12. Will I need blood?

13. How soon should this be done?

14. How is/are the eye(s) bandaged?

15. What kind(s) of medication does one take during the recovery (if any)?

16. How long is the recovery?

17. Am I required to stay in the hospital for a period of time?

18. What kind of time frame (overall) am I looking at?

19. Am I limited from activities for a period of time?

20. Could this problem return?

21. Will I be able to return to wearing my contacts, and how soon?

Here is how I (EMH) answered these questions:

1. Yes.

2. Not a very good one if you want to see one object (avoid diplopia) in a wider field of vision.

3. 30 years. (This is a tough one for the "new guy", you will just have to work this out.)

4. Yes, but I have help from fellows and residents.

5. I have done approximately 4,000 to 5,000 strabismus surgical procedures. Among these approximately 30 have been for bilateral superior oblique palsy. (Again if this is your first, work it out.)

6. We move one or more muscles to a different position on the eyeball through a small incision in the conjunctiva (loose white covering of the eye). Sometimes we shorten the muscle by taking a peice out and sometimes we take a tuck in a muscle or tendon.

7. We operate on both eyes at one procedure if necessary.

8. Very unlikely, but if this happens we can work with you to make the situation better.

9. With a 100% effort at making the current procedure the last eye surgery for you, there is a 40% chance you will need additional surgery. Your particular case, bilateral superior oblique palsy, is a difficult one.

10. With 1.25 surgeries per patient our success rate is between 90% and 95%.  By success in your case, I mean single binocular vision in a useful field of vision.  But, you will have double vision, less often than before your injury, mostly when you look in extremes of gaze.

11. Several factors including complicated strabismus like yours, improper diagnosis, poor technique, and just plain bad luck.

12. No.

13. It can be done at any time.

14. No eye patches are used ordinarily.  If your cornea dries out or is scratched during surgery, you may need a patch for 24 hours.  We never patch both eyes.

15. Tylenol or other mild analgesics may be used and a combination of antibiotic and steroid drops are used twice a day for 1 week or occasionally longer.  Some surgeons use no post-operative drops.

16. It depends.  Most people can resume moderate activity the next day including reading and watching TV.  Most people can return to work in a clean environment in 2 or 3 days (including school).  Work in a dusty or dirty environment may require a patient to be off work for a week or more.  We discourage swimming for 2 weeks, although you can shower and wash your hair right away.  Nothing will "break or come loose".

17. The procedure is outpatient: the surgery takes 30 to 60 minutes and the total time you will spend at the surgery facility will be approximately 4 hours.

18. We examine you at 1 week and 8 weeks postoperatively as a routine, but more frequently if needed.

19. This has been answered above for the most part.  School age children should be excused from physical education for two weeks.  Adults can resume full activity as tolerated.  Bending, stooping, and lifting is okay.  The muscles will not break or come loose.  Use common sense.

20. Not as it occurred originally, but you may have persistent symptoms if the surgery is not entirely successful.

21. You can wear contact lenses in about 1 week.