Risk Management

Strabismus Surgery Consent (Addendum to General Consent Form)







Complications which could occur weeks, months, or even years later

  1. Infection
  2. Accidental penetration of the eye
  3. Over- and under-correction
  4. Double vision
  5. Unusual suture reaction
  6. Loss of vision or loss of eye


Local complications of anesthesia injections around the eye:

  1. Perforation of eyeball
  2. Destruction of optic nerve
  3. Interference with circulation of retina
  4. Possible drooping of eyelid
  5. Respiratory depression
  6. Hypotension


Additional comments:







Patient (or person authorized to sign for patient)                                   Date






Witness                                                                                                          Date

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