The eye muscle surgery process begins with a thorough evaluation of the eye condition to identify the muscles responsible for the misalignment and the degree of adjustment needed. The surgery is usually performed under general anesthesia for children and most adults, or under local anesthesia with sedation for some adults. In some cases, adjustable sutures may be used to fine-tune the alignment immediately after the surgery. The surgeon makes a small incision in the conjunctiva, the thin membrane covering the white part of the eye (sclera), to access the eye muscles underneath. There are two main procedures: weakening a muscle (Recession) by detaching it from its original insertion point on the eye and reattaching it further back, which reduces its pull; or strengthening a muscle (Resection) by removing a small section of the muscle and reattaching it to its original position, making it shorter and stronger. The surgery may involve working on one or more muscles in one or both eyes. The conjunctival incision is closed with fine, dissolvable stitches. The surgery typically takes between 30 minutes to two hours depending on the complexity and the number of muscles being adjusted.