Squint:

A Squint (Strabismus) is a condition of the eye that causes one of the eyes to turn inwards (converge), outwards (diverge) or sometimes upwards, while the other eye looks forward. The cause, severity, and direction of a squint vary from person to person. It is usually spotted in childhood, sometimes within weeks of a baby being born, and affects 5-8% of children (1-2 in every 30).
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A squint can occur for a number of reasons, these include:

Poor vision in one or both eyes
A need for glasses
Poor development of the eye muscle control centres in the brain
Damage to the nerves controlling eye muscles

What causes a Squint?

There are six muscles attached to the outside of each eye that are responsible for eye movements. When there is an imbalance of these muscles, a Squint occurs. The cause of the squint may not be obvious but can include a family history, long or short sightedness, injury or viral illness.

SYMPTOMS:

The most common symptom of a Squint is one of the eyes not looking straight ahead. In newborn babies it is quite normal for their eyes to ‘cross’ occasionally, particularly if they are tired. However, if you notice that this happens to your child beyond three months of age, it is advisable to talk to your ophthalmologist.

Your child may also look at you with one eye closed, or with the head turned to one side. These may be clues that they are experiencing double vision, and could be a sign that they have a Squint.

TREATMENTS:

A Squint is a condition that should be treated as soon as possible after it’s detected. Treatment is most effective in very young children.

A Squint will not disappear as the child gets older, and in fact the sight in the affected eye will gradually get worse.

There are several types of treatment available:

If your child is long sighted, glasses may be prescribed which can often correct the long sight and squint.
Alternatively, a patch may be needed to be worn over the good eye, to encourage the eye with the squint to work harder and become trained to work properly.
In some cases, the Squint can be treated with special eye drops, or with eye exercises.

If none of these treatments helps, then surgery may be required. Surgery for Squint involves moving the muscles attached to the outside of the eye to a new position. It may sometimes be necessary to operate on both eyes in order to ‘balance’ them effectively, even if the Squint is only in one eye.

If your child is long sighted, glasses may be prescribed which can often correct the long sight and the Squint.

Non-Surgical treatment modalities

Prisms, refractive lenses and pharmacologic measures have been used to help patient achieve fusion (alignment of the eyes) and alleviate diplopia, in addition to surgery. Some patients will adapt by suppressing the vision of one eye to eliminate their diplopia. An additional technique is the use of Botulinum toxin.

FAQS:

If my child needs an operation what happens next?

Your child will be sent an appointment for pre-assessment where we will measure the size of the Squint. The surgeon will see you and your child to discuss the details of the surgery. Our anesthetist would examine the child and advise any laboratory investigations for fitness for the surgery.

Are there any risks?

Although most Squint operations successfully straighten the eyes all surgery carries risks and Squint surgery is no different. The following are recognize

There may be some bruising on the eye, which can make it look red for a few weeks.
There may be under or over correction of the Squint.
There may get some double vision although this often settles.

The result of Squint surgery is not completely predictable as the healing and the brain-eye coordination are variable. If the eye is not quite straight after the operation it may settle by the three month post-op appointment. If it does not then we may need to prescribe prisms or do a further operation to improve the position of the eyes.

Adjustable Stitches

In some adults who undergo Squint surgery a better surgical outcome may be achieved by using adjustable stitches. The doctor will tell you if this is an option. The operation is performed under general anaesthesia and the stitches are tied in a bow at the end of the operation. You are then woken up and the eyes position measured.

If the eye position has not been altered enough we can tighten up the bow to adjust the position, using some drops to numb the eye. This makes the operation more precise , especially, when there has already been previous surgery.

Post Operation

The eye will be mildly sore after the operation for a few week days. Redness will last for two to four weeks, but will get better each day.
Covering the eye is not necessary
Your child’s tears will appear a little blood stained for few days. This is normal.
The stitches used in Squint surgery are dissolving, so will not require removal.
You will need to use eye drops or ointment as per doctor advice.
If your child wears glasses, he can continue to wear them after the operation unless told otherwise by your consultant.
Your child’s eye may be little sticky after the operation, and the lids may be stuck together with mucus after sleep. This can be cleaned by using cooled boiled water and cotton.
If the stickiness and redness do not improve each day or gets worse contact your ophthalmologist.

Article by
Sankara eye care