PAEDIATRIC OPHTHALMOLOGY & STRABISMUS – 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).

CAUSES

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.

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

SYMPTOMS

• The most common symptom of a Squint is one of the eyes not looking straight ahead. In new-born 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.

TREATMENT

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.

EXPLORE 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 amount of squint. The surgeon will see you and your child to discuss the details of the surgery. Our anaesthetist 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 recognized risks:

  • 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 plan further intervention 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 inform you if this is an option. The surgery is performed under general anaesthesia and the stitches are tied in a bow at the end of the operation. The patient is then woken up and the eye position measured.

After the eye position has been measured, it can again be altered, if necessary, to achieve the required result. This makes the procedure more precise, especially, when there has already been previous surgery.

POST-SURGERY

Post-surgery

  • The eye will be mildly sore for a few days. Redness may 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 absorbable, 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.

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