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September 27, 2012
Surgery for Crossed Eyes Not Just for Kids
MAYWOOD, Ill. - Since she was a child, Katie Szymczak has had eyes that wandered. Her right eye wandered the most - rather than staring straight ahead, it would look up and to the side.
Szymczak underwent corrective surgeries when she was a child and a young adult, but the surgeries did not completely fix the problem.
Her husband affectionately called them "googly eyes." But other people could be mean. "They would say to me, 'What's wrong with your eyes? Why aren't you looking at me?' " said Szymczak, now in her early 40s. "That hit me to the core. It really hurt a lot."
But since Dr. James McDonnell, an ophthalmologist at Loyola University Medical Center, performed surgery to repair the defect, Szymczak's eyes have been in a normal position.
"I don't get comments anymore," she said.
Szymczak is less self-conscious now and more confident doing presentations at work. And she has begun wearing eye makeup. "I feel I can show them off now," she said.
McDonnell has performed thousands of corrective surgeries in children and adults whose eyes are misaligned for various reasons. But many adults who have this defect, called strabismus, wrongly believe there's no treatment.
Patients are given many reasons why they shouldn't get treatment: Nothing could be done after a certain age; they would outgrow the problem; they would need another surgery or if they had undergone a previous surgery nothing further could be done. Some patients are told that insurance won't cover the procedure.
"None of these things are true," McDonnell said. "This type of misinformation can come from friends, family doctors, and even ophthalmologists and optometrists."
McDonnell has performed the procedure on patients ranging in age from infancy to past 90, with excellent outcomes. In addition to restoring normal appearance, the surgery also can improve depth perception and eliminate double vision or eye strain.
About half of the strabismus surgeries McDonnell performs are on adults. To correct the misalignments, he operates on the muscles that control the movement of the eyes. He uses a different technique than those typically used on children. In some patients he uses an adjustable suture technique that allows him to fine-tune the eyes into the exact alignment.
“Our goal is to restore patients' eyes to a normal functional alignment so they can use their eyes together to the best of their ability," McDonnell said. “We want them to be able to look anyone directly in the eye and feel confident that their eyes appear normal. When you can't look someone in the eye, it affects your fundamental ability to communicate. It can be very debilitating."
Risks of the outpatient surgery, which are very rare, include infection and detached retina.
Many adult patients have had the condition all their lives. Others develop strabismus as a result of such conditions as stroke, tumor or brain injury. Studies show these patients think about their eyes almost every hour of every day.
"You become very self-conscious about it," said William Stofan, 59, who underwent surgery on his right eye, which drifted to the right. "I would not even think about asking a woman for a date."
Stofan said not being able to make eye contact was horrible. "When people looked at me, I felt like a freak," he said.
Stofan said he has had strabismus for years, but the condition became more noticeable about two years ago. He would make jokes about it, "but it got to the point where it wasn't funny anymore."
The surgery caused minimal pain; Stofan took just one dose of ibuprofen the next day. "I'm back to being the old me," he said. "My confidence is stronger than it ever was."
McDonnell said the surgery is very rewarding. "There are always tears of joy and relief from the patient and from me," he said. "I’m like the town crier, but it’s just so wonderful and humbling to see each person after surgery. It’s a shame when patients wait years to correct something we can address in about one hour."
Some adult patients can be treated with Botox, which temporarily weakens muscles. The drug weakens the pull of a strong muscle, allowing the weaker muscle to gain strength. When the drug wears off in about two months, proper muscle balance and eye alignment often are restored, McDonnell said.
McDonnell is a professor in the Department of Ophthalmology at Loyola University Chicago Stritch School of Medicine. He was named to Chicago magazine's 2012 list of Chicago's Top Doctors.
Loyola University Health System (LUHS) is a member of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and more than 30 primary and specialty care facilities in Cook, Will and DuPage counties. The medical center campus is conveniently located in Maywood, 13 miles west of the Chicago Loop and 8 miles east of Oak Brook, Ill. The heart of the medical center campus is a 559-licensed-bed hospital that houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children's Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as the LUC Stritch School of Medicine, the LUC Marcella Niehoff School of Nursing and the Loyola Center for Fitness. Loyola's Gottlieb campus in Melrose Park includes the 255-licensed-bed community hospital, the Professional Office Building housing 150 private practice clinics, the Adult Day Care, the Gottlieb Center for Fitness, Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.