A Closer Look at Adjustable Sutures in Pediatric Strabismus Surgery

When a child’s eyes are misaligned—a condition known as strabismus—surgery is sometimes needed to help the eye muscles work together properly. One of the most effective innovations in this surgery is the use of adjustable sutures. These special stitches give the surgeon the ability to fine-tune the eye’s position after the operation, greatly improving the chances of success.

Though adjustable sutures have long been used with adults, specialists at University Children’s Eye Center have pioneered ways to safely and effectively use them with children. Large-scale studies have shown that children who receive strabismus surgery with adjustable sutures have a significantly higher success rate. They are also less likely to need a second surgery.

Strabismus can take many forms: an eye that turns inward (esotropia), outward (exotropia), upward (hypertropia), or downward (hypotropia). Sometimes, a child may appear to have crossed eyes due to the shape of their nose or eyelids (also known as pseudostrabismus), but only an eye exam can confirm whether true misalignment is present.

Some level of misalignment is normal in newborns, especially those born early. However, such misalignment should resolve itself by 4 to 6 months of age. If the eyes are still not consistently aligned after that point, a pediatric eye specialist should probably get involved.

Without timely treatment, the misaligned eye may become weaker, a condition known as amblyopia, or “lazy eye." If this happens, the brain may lose the ability to use both eyes together.

Depending on the cause and type of strabismus, treatment may involve glasses, patching, eye drops, or surgery. And that's where the sutures come into play! They offer an extra layer of precision and long-term benefit. For parents, this means fewer follow-up procedures and a better chance that their children will enjoy clear, coordinated vision as they grow.