Squint & lazy eye

The week after squint surgery: what recovery actually looks like

The operation is done and the pad is off, and now the eye looks nothing like you pictured. Here is what is ordinary in the days and weeks that follow, and the short list of things that are not.

by Dr Chan Li Yen · MBBS, MOphth (UM), Fellowship in Paediatric Ophthalmology & Strabismus

Practises at Hospital Kuala Lumpur 11 min read · 1,942 words

Key takeaways

A red, watery, scratchy eye with faintly blood-tinged tears is normal for several weeks and sometimes months after squint surgery.
Mild double vision and small day-to-day changes in how straight the eye looks are expected while the alignment settles, not signs the operation has failed.
Drops, school dates, screen time and swimming are general guidance here; your own child's surgeon sets the actual dates for your child's operation.
Swimming is usually the longest wait, around three to four weeks, because pool water irritates a healing eye and raises infection risk.
Worsening pain, increasing lid swelling or redness, thick or yellow-green discharge, a fever, or any drop in vision mean calling the hospital the same day.

The pad comes off, the discharge letter is signed, and the questions do not stop. They just change. What happens on the day of squint surgery covers the operation itself and the drive home. It helps to know in advance what the weeks after that drive look like, and how much of it looks alarming while being completely ordinary.

What counts as normal in these first few weeks?

A red eye, a scratchy feeling, watering, and tears that look faintly blood tinged. All four are ordinary. The white of the eye is expected to stay red for several weeks, and occasionally for months, while the tissue underneath heals. That is what healing looks like from the outside, not a sign something has gone wrong. The scratchy, gritty feeling settles faster than the redness does, usually within the first few days, as the dissolving stitches stop irritating the surface.

Double vision in the first week or two is common as well, and it usually passes as the brain adjusts to the eye's new position. The alignment itself can look slightly different from one day to the next while it settles: straighter one morning, a touch off the next. That is expected movement in the healing weeks, not the surgery failing, and it is one reason the follow-up visit is timed weeks out rather than the day after.

A healing eye often looks worse before it looks better, and that order is exactly right.

How much pain should I expect, and what can I give?

Usually manageable, and it should trend downward from day one rather than staying flat. The soreness is worst with eye movement, often felt as grit or sand, and it usually improves within the first few days even while the redness is still going strong. Simple paracetamol at the right dose for your child's weight is the usual first choice for discomfort, and it can be repeated as directed on the packaging. Children under sixteen should not be given aspirin, and if there is any chance of bleeding inside the eye, an anti-inflammatory such as ibuprofen is one to check with your surgeon before giving, since it can affect bleeding risk in some situations.

A cool, clean compress held gently near the eye, rather than pressed onto it, can help with general soreness and swelling in the first day or two. It is a comfort measure rather than a treatment, and it does not replace watching for the signs further down this page.

How do I manage the eye drops, and for how long?

Most children go home with a combined antibiotic and steroid drop, or an antibiotic ointment, to use for one to a few weeks depending on what was done in surgery. The antibiotic guards the healing surface against infection, and the steroid component calms inflammation. Follow the exact frequency and length your child's own surgeon wrote down. A course run shorter or longer than prescribed is sometimes chosen for a specific reason in a specific child, and this is not the instruction to improvise on.

Getting drops into a child who does not want them is its own small battle, and it is worth practising the technique before this week rather than during it. The technique for getting drops into a small human covers positioning that makes it easier. Wash your hands before each dose, wipe away any crust with cooled boiled water on a clean pad rather than a fingernail, and leave a short gap between different drops if more than one is prescribed.

When can your child go back to school, and what about screens?

Most children return to school around a week after surgery, and screens and reading can generally resume as soon as your child is comfortable looking at them. A scratchy, light-sensitive eye tends to set its own pace here more than any fixed rule does. Both of these are general guidance, and your own surgeon's instructions come first, particularly if more than one muscle was operated on or your child's own recovery is running slower than the average.

Dusty playgrounds, sand pits and face paint are usually held off for about two weeks, since grit against a healing surface is exactly the irritation everyone is trying to avoid. None of this needs to be enforced through fear. A tired, slightly cranky child who wants a few more minutes of a tablet after a hospital visit is not undoing the operation.

Full healing takes longer than the week off school suggests, which is worth knowing in advance so it does not feel like something went wrong. A child can be back at their desk and still be only halfway through the redness clearing, so some tiredness, some rubbing at the eye out of habit, and some complaining about bright classroom light in that stretch are ordinary rather than a setback.

When can your child swim again?

Swimming is usually the longest wait, generally three to four weeks, because chlorinated water irritates a healing eye and pool water carries a higher infection risk while the stitches are still dissolving underneath the surface. Contact sport and rough play at the same intensity wait a little longer again, closer to six weeks in some guidance, for the same reason: a knock or a splash to an eye that has not finished healing is a different injury from the same knock to a healed one. The exact number of weeks for each activity is your surgeon's call, since it depends on which muscles were touched and how your particular child's eye is healing.

What should send us back to the hospital the same day?

Five things, and any one of them alone is enough. Pain that is getting worse instead of settling, particularly from a couple of days after surgery onward. Swelling or redness of the eyelids that is clearly increasing rather than improving. Discharge that turns thick, or a noticeably yellow or green colour, rather than the occasional clear or white crust that is expected on waking. A fever, or a child who seems generally unwell rather than simply tired and grumpy. And any drop in vision in the operated eye, or vision that looks different from how it was before surgery. A healing eye should look a little better with each passing day, not worse. When it does not, that is the same-day call, not the next routine appointment.

What happens at the follow-up appointment?

The orthoptist or surgeon checks how the eye has settled, measures the alignment again, and confirms the redness and healing are on track. This is usually booked for a few weeks after surgery rather than the week itself, because that is roughly how long the true result takes to show. If your child wore glasses before surgery, they carry on wearing them afterwards, since how the two eyes learn to work as a pair depends on focus and alignment being managed together, not one instead of the other. If a lazy eye was part of the picture, patching usually continues on its own separate schedule too, sometimes with more of it for a while rather than less.

Bring any of the same-day concerns above to that appointment early rather than saving them up, and bring the small day-to-day ones as well, however minor they feel. Your child's own surgeon is treating your particular child's eye, not a general timetable, and their instructions on drops, dates and follow-up always come before anything written here.

It is also worth saying plainly that needing more than one operation over childhood is not unusual, and a squint drifting slightly in the months after surgery is not the same thing as the operation having failed on the day. That longer view belongs to the surgeon who did the surgery, and the honest answer to how this particular eye is settling will always come from them rather than from an average taken across many other children.

Contact the hospital the same day if…

The pain is getting worse rather than settling, especially from a couple of days after surgery onward.
The eyelids are more swollen or red than they were, rather than gradually improving.
The discharge turns thick, or a noticeable yellow or green colour, instead of the usual occasional clear or white crust.
Your child has a fever or seems generally unwell, not just tired and grumpy.
Vision in the operated eye drops or looks different from how it was before surgery.

Common questions

How long will my child's eye stay red after squint surgery?

Often for several weeks, and occasionally for a few months, especially after a repeat operation. This is expected while the tissue over the muscle heals, and it is not on its own a sign of a problem. The soreness and grittiness usually settle faster than the redness, often within the first few days.

Is it normal for my child to see double after the operation?

Yes, in the first week or two, as the brain adjusts to the eye's new position. It usually eases on its own over that time. Double vision that is getting worse rather than better, rather than simply present, is one of the things to mention to the surgical team promptly.

What painkillers can I give, and what should I avoid?

Paracetamol at the correct dose for your child's weight is the usual first choice, and it can ease the scratchy soreness that is worst in the first few days. Children under sixteen should not be given aspirin. Check with your surgeon before giving an anti-inflammatory such as ibuprofen if there is any chance of bleeding inside the eye.

When can my child go back to school and back to screens?

Most children return to school around a week after surgery, and reading or screen time can usually resume as soon as your child is comfortable looking at them. Dusty or sandy play and face paint are usually held off for about two weeks. These are general guides, and your own surgeon's instructions for your child's operation come first.

How long do we really need to wait before swimming?

Generally three to four weeks, because chlorinated pool water irritates a healing eye and carries a higher infection risk while the stitches are still dissolving. It is usually the longest wait of the whole recovery. Confirm the exact date with your surgeon.

What discharge or crusting is normal, and what is not?

A little clear or white crust on waking, wiped away with cooled boiled water on a clean pad, is ordinary in the first week or two. Thick discharge, or a noticeably yellow or green colour, is not, and is one of the same-day signs to call the hospital about rather than waiting for the drops to work it away.

Do the stitches need to be removed?

No. The stitches used in squint surgery are the kind that dissolve on their own over one to two weeks, sitting behind the surface rather than on top of it, so there is nothing to see and nothing to have taken out at a later appointment.

How will we know if the surgery has actually worked?

Not from the first week, since the eye is still swollen, red and settling into its new position during that time. The follow-up appointment, usually booked a few weeks after surgery, is when the surgeon measures the alignment properly. Needing a further operation at some point is common and does not mean the first one failed.

References

NHS · Squint, surgery · www.nhs.uk
AAPOS · Strabismus surgery · aapos.org
Moorfields Eye Hospital · Surgery for squint (strabismus), information for parents · www.moorfields.nhs.uk
Royal Devon University Healthcare NHS Foundation Trust · Post-operative Care Following Squint Surgery · www.royaldevon.nhs.uk
Guy's and St Thomas' NHS Foundation Trust · Surgical wounds and preventing infections · www.guysandstthomas.nhs.uk

By Dr Chan Li Yen. General information only. It does not replace a consultation. If you are worried about your child's eyes or vision, please see an eye doctor.