EXPECTATIONS AND INSTRUCTIONS FOLLOWING SQUINT SURGERY FOR CHILDREN

The Surgery

The eye is shaped like a large marble and the muscles look like elastic bands attached to the side of the eye. When the muscles move the eye changes position. Surgery involves attaching and reattaching the muscles to another place on the eye. The incision goes through the white part of the eye. Most of the time the healing hides any scarring so it can hardly be seen after 2-3 months unless you know exactly where to look and look very carefully.

Normally a first surgery takes approximately an hour. This includes the time that the patient is brought in to the Operating Room until the time the patient goes to the Recovery Room. Re-operations take longer.

What if my Child is Sick?

If your child has a chronic illness or syndrome ask your GP or pediatrician if the anaesthetist needs to be informed in advance. We will provide you with the anaesthetist's contact details before the surgery.

Asthma

If your child has asthma go to the GP about 10 days before the surgery to discuss increase in regular medications before the surgery.

If your child has a cough or cold two days before the date scheduled for surgery, go to your GP for a checkup and let this office know the outcome of that visit.

If your child has a fever or noises on the chest on the day of surgery you should come to the hospital but it is likely that the anaesthetist will not proceed, and we will schedule another date.

Hospital Stay

Children go home the same day providing:
· The operation is less than 1 hour duration
· Home is less than 1 hour's drive
· The child recovers well from the general anaesthetic.

Children who come from the country, interstate or overseas are usually discharged in the care of their parents to a nearby hotel. Dr Kowal usually needs to see the child within 24 hours of the surgery to assess that sutures haven't slipped etc., and sometimes the next day as well. You should plan to stay for 2 days after the surgery.

School - Plan to stay home from school for one week.
Swimming - Swimming can be resumed after a week. The eyes will be redder following exposure to chlorine.

What to Expect on Leaving Hospital

1. Eyelids may be swollen. Ice packs are very good at lessening this swelling and for lessening any pain. Make-up remover pads (DeMakeUp) soaked in ice water feel good.
2. There will be red stained tearing for one or two days.
3. In the first day after surgery the amount, colour and intensity of redness on the operated eye(s) can be quite scary - it always gets better, and starts getting visibly better within 2-3 days. Sometime in the second week after surgery most of the redness has gone though it can take several weeks to look normal.
4. There will be some sticky discharge in the mornings that may stick the eyelids together. Wipe away any discharge using a freshly opened pack of cotton balls or make-up remover pads with saline solution. The best saline solution is "Normal Saline for Contact Lens Users" which you can buy in a 500ml bottle for about $3. If the discharge continues when the eyes are open then tell the doctor - it could mean an infection.
5. Double vision is sometimes present. Doctor will tell you if this is to be expected. Ring the doctor for advice if this occurs and has not been mentioned to you.
6. Usually no eyepad.
7. A child will be irritable for 1-2 days. Expect some sleep and behaviour disturbance for several days. Some children are very frightened by the whole experience and need patient TLC for a few days. Some children bounce back very quickly and are fine within a few hours.
8. Vomiting:
· Vomiting is uncommon with modern anaesthetic techniques. The patient will be tried with icy pole and fluids before being allowed to leave the hospital, and must keep fluids down before being allowed to leave.
· May be car sick on the way home. Be prepared.
· The patient should tolerate fluids at home. "Slurpee" is good - the cold crushed ice settles a nauseous tummy. If vomiting is still happening after 12 hours call Dr Kowal or Casualty Department (9929 8666) for advice.
9. The eye will have a feeling of sand or dust in the eye due to the cut edges and the very fine stitches on the surface.
10. There may be soreness over the muscles and it may hurt to move the eye in a particular direction.

Eye Rubbing after Surgery.

Parents are usually worried that if their child rubs the eyes after strabismus surgery something will go wrong. This fear is largely unwarranted. If your child rubs the eyes, s/he will always close the lids first so s/he cannot actually rub the eyeballs directly.

The stitches holding the muscles in place are very deep and cannot be disturbed by eye rubbing. Some very superficial stitches might be disturbed by eye rubbing. At worst this can delay healing, keep the eye redder for longer, and necessitate some extra visits for check-ups over the first 2-3 weeks.

Course

Each post-operative day should be better than the previous one. There should be progressively less redness and progressively less discomfort. A "turn for the worse" is potentially serious and you must call me quickly.

To Reduce Anxiety in Children:

· Before Surgery:
a) Child may bring a favourite toy.
b) Hospitals and anaesthetists usually invite one parent into the operating theatre.
c) Operating theatres all have a CD player. It's nice to have your child's favourite music playing as s/he comes into the operating theatre - it would be appreciated if you could bring a clearly labelled CD with you to the hospital so that this can happen.

After Surgery:

a) During the operation, a child is given intravenous Panadol to lessen post-operative pain. The intravenous line is usually left in so further Panadol can be given if necessary. Dr Kowal will usually give an injection of anaesthetic around the eye for post-op pain relief as well. This injection can cause a weird eye position for up to 24 hours and the preliminary surgical result cannot be assessed accurately over this time.
b) Panadol and Nurofen alternating every 4 hours while awake in the first 24 hours following the operation for irritability and discomfort. "Painstop" if Panadol is not strong enough.
c) Children are sometimes frightened to open their eyes after surgery. Reassure them that it's fine to keep them closed and just wait.

Eye Drops

In older children there are usually two bottles to be used for one week, antibiotic and cortisone.
In younger children, drops are usually "too hard" and only used if the eyes are particularly red or irritable, or if infection is suspected.
If drops have to be used in younger children, we try to limit them to once or twice a day. They can often be put in when the child is asleep (pry open the lids just a little and drop the drop onto the white of the eye).

Glasses

If the patient usually wears glasses bring them to the hospital. The doctor will tell you when you go home if they are to be continued.

Post Operative Visit

When you go home a follow up appointment card will be given. In the first 24 hours after surgery feel free to contact Dr Kowal at ANY time if you have any problems - his home number is 9827 7827. If not answering, the hospital switchboard can contact him on his mobile.

Unfortunately no surgery is 100% reliable and 100% safe. You maximise your child's chances of success and minimise chances of problems by choosing a surgeon who is highly trained and specialised. Dr. Kowal is the only eye surgeon in Australia whose practice is restricted to strabismus.

Dr. Kowal does not suffer from any transmissible virus (HIV, Hep B, Hep C). Dr. Kowal reserves the right to ask if you do.