Eye muscle surgery is surgery to weaken, strengthen, or reposition any of the muscles that move the eyeball (the extraocular muscles).

The purpose of eye muscle surgery is generally to align the pair of eyes so that they gaze in the same direction and move together as a team, either to improve appearance or to aid in the development of binocular vision in a young child. To achieve binocular vision, the goal is to align the eyes so that the location of the image on the retina of one eye corresponds to the location of the image on the retina of the other eye.
In addition, sometimes eye muscle surgery can help people with other eye disorders (nystagmus and Duane syndrome, for example).

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Depth perception (stereopsis) develops around the age of three months old. For successful development of binocular vision and the ability to perceive three-dimensionally, the surgery should not be postponed past the age of four. The earlier the surgery the better the outcome, so an early diagnosis is important. Surgery may even be performed before two years old. After surgery, if binocular vision is to develop, corrective lenses and eye exercises (vision therapy) will probably be necessary.

The extraocular muscles attach via tendons to the sclera (the white, opaque, outer protective covering of the eyeball) at different places just behind an imaginary equator circling the top, bottom, left, and right of the eye. The other end of each of these muscles attaches to a part of the orbit (the eye socket in the skull). These muscles enable the eyes to move up, down, to one side or the other, or any angle in between.

Normally both eyes move together, receive the same image on corresponding locations on both retinas, and the brain fuses these images into one three-dimensional image. The exception is in strabismus which is a disorder where one or both eyes deviate out of alignment, most often outwardly (exotropia) or toward the nose (esotropia). The brain now receives two different images, and either suppresses one or the person sees double (diplopia). This deviation can be adjusted by weakening or strengthening the appropriate muscles to move the eyes toward the center. For example, if an eye turns upward, the muscle at the bottom of the eye could be strengthened.

Rarely, eye muscle surgery is performed on people with nystagmus or Duane syndrome. Nystagmus is a condition where one or both eyes move rapidly or oscillate; it can sometimes be helped by moving the eyes to the position of least oscillation. Duane syndrome is a disorder where there is limited horizontal eye movement; it can sometimes be relieved by surgery to weaken an eye muscle.

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