While orthoptic exercises or prism glasses are sufficient for some patients with strabismus, many require surgery in order to correct their alignment. Most often, this is achieved with incisional surgery. Chemodenervation, covered at the end of this chapter, is an alternative for some patients.
The history and a detailed evaluation of ocular motility, as part of a complete ophthalmologic examination, provide the information necessary for the surgeon to plan optimal strabismus surgery. Evaluation, tailored to the type of case, may include sensory binocularity testing, forced duction testing, active force generation, and saccadic velocity measurement. Simulation of the target postoperative alignment with prisms or an amblyoscope may be used to assess the risk of diplopia and the potential for single binocular vision (see Chapter 7 for discussion of these tests). Preoperative discussions should address the expectations of the patient and family, as well as the risks and potential complications of strabismus surgery, especially if surgery on the only eye with good vision is considered.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.