WELCOME! WE ARE JACKSONVILLE FLORIDA'S ONLY PRIVATE PRACTICE DEDICATED TO FULL TIME EXPERT SURGICAL AND MEDICAL TREATMENT OF PEDIATRIC AND ADULT EYE MUSCLE DISORDERS.  OUR PATIENTS COME FROM NORTHEAST FLORIDA AND AROUND THE WORLD. This is a small, personal private pediatric and adult ophthalmology practice where care is provided to all ages from infancy through senior years.

Dr. Adam D. Koenigsberg is board certfied in Ophthalmology by the American Board of Ophthalmology. He is fellowship trained in Pediatric Ophthalmology and Strabismus.  He is an expert in surgical correction of eye muscle disorders in adults and children.  He is an eye muscle specialist and performs corrective surgery to straighten and align eyes which cross, drift and float. This is done for cosmetic as well as medical reasons.

The purpose of eye muscle surgery, otherwise known as strabismus surgery, is to correct the malpositioned ocular appearance. Many patients are under the assumption that the inability of the eye or eyes to appear or remain straight  is muscular in origin. In fact, in most cases, the problem is usually neurologic, genetic or secondary to some external factor. Children who are born with crossed eyes, or have eyes which drift for example, do not have a particular problem with a muscle. Rather, the brain, for reasons which are not clear, did not learn to understand how to use the eye or eyes together for various reasons. The neuronal connections or “wires” which connect the brain or “master organ” with the eyes do not work correctly and therefore the eyes do not move in unison, or invidually in the correct fashion, in the direction in which one would expect them to. In some cases, the matter is genetic and some patients similarly are born or acquire a problem where the eyes do not work properly individually or together and similarly the problem usually rests with the brain and its connections to the eyes. Finally, in some situations, an eye position abnormality may rest with an outside source such as a stroke, aneurysm, and brain tumor, or after a traumatic event such as a serious accident. 

Therefore the purpose of eye muscle surgery is to correct the improper movement of the eye or eyes, but as you will now understand the problem is only rarely a true problem of the eye muscle itself. Since the key is in understanding the complicated nature of the problem in the innervation of the muscle, patients will understand the benefits as well as the limitations of what eye muscle procedures can accomplish. In essence, the surgeon attempts to repair the position of the eyes via muscular procedures in an effort to "re-teach” the  brain how to use the eye or eyes correctly. In some ways, it is an elegant form of peripheral neurosurgery, working on the endpoint of the brain’s control, namely the eye muscle or muscles.

 What can eye muscle surgery do for a patient? It can restore normality in appearance, help to enable the eyes to work together better, and in some cases reduce or eliminate double vision from their malposition. Since the problem is not the end point or eye muscle itself, the chance of repeat surgery, namely, a second or third procedure is 25% in the USA. This is due to the fact that the clinical problem is related to the "wiring" or "neuronal connections."

The surgeries themselves are very straightforward and usually performed in an outpatient surgery setting. They can be performed under local (where is patient is relaxed but awake) or general (the patient is “asleep”) anesthesia. This is often left to patient preference. The selected muscles of the eyes are visualized under a mounted microscope which the surgeon wears, much like a very high power microscope that a jeweler would use to evaluate a gem under high magnification. The muscle in question can be isolated with special hooks and then detached from the eye, and gently moved into a new position and sewn with self-dissolving stitches into the new, desired position. Muscles can be shorted and tightened  (resected) to strengthen their effect, or relaxed and lengthened (recessed)  to weaken their effect.

 Patients sometimes fear the eye will be removed during surgery. This is not the case. The surgery is elegant and sophisticated, and only the muscles are gently manipulated while the eye remains in perfect position in the socket. The procedure is not painful, and the post operative discomfort is moderate and lasts usually 1-3 days and can be controlled with Tylenol or sometimes stronger prescription pain medication if needed, depending on the patient and the procedure involved.  During the first week or two the eyes will appear red and irritated. This disappears by 3-4 weeks. Most patients return to work or school within 3-4 days easily. Healing typically takes approximately one month during which the brain learns how to use the eye or eyes in their new positions. Within one month it is difficult to tell that surgery has occurred. Some exceptions occur for patients who are undergoing complex revisions of prior procedures done during earlier times in their lives. In this situation, the eyes can remain irritated longer. 

Eye muscle surgery can be performed additionally under a special technique, depending on patient preference, in which the muscles are “adjusted” via a special sliding stitch several hours after the procedure to maximize the appearance and position of the muscle. This approach has its benefits and disadvantages and we discuss each approach and type of procedure in this practice thoroughly prior to making a final decision. 

Eye muscle surgery therefore remains both an art and science. Its predictability can be excellent and most patients are extremely pleased with their new appearance and in some cases, the elimination of significant problems that occur with poorly positioned eyes. This includes elimination of the psychological and social problems inherent with looking “different.” As mentioned previously it can also reduce or eliminate double vision, improve depth perception (3- dimensional vision) depending on the age and patient situation, and also therefore sometimes improve “binocular” vision or the vision with both eyes open at the same time. Finally, eye muscle surgery can reduce the complicated appearance of eye muscles that can occur after strokes and trauma additionally. 

We hope this information is helpful and we encourage you to ask as many questions as you like should you visit our office. Eye muscle surgery, when the proper clinical situation is chosen, can be an enormously powerful tool in restoring normal appearance and eliminating significant medical and psychosocial problems for our patients.

OUR PATIENTS ARE OUR COMPLETE PRIORITY. WE WELCOME YOU TO OUR PRACTICE.