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Squint Consultation

Squint Consultation

Squint is a condition affecting the alignment of the eyes that can be seen in children or adults. As an individual attempts to focus on an object, one eye turns in another direction and the eyes become misaligned. In addition to the cosmetic concerns commonly associated with this condition, squint can result in double vision. Though a person can be born with strabismus/squint, the condition can also be caused by head injury, disease, or poor vision in one eye.

When the eye muscles are too strong or too weak, strabismus can occur. Since the eye uses six different muscles in order to move, there are many different ways in which strabismus can manifest. There are three main types of strabismus :

  • Esotropia: when one or both eyes turn inward
  • Exotropia: when one or both eyes turn outward
  • Hypertropia: when one eye appears at higher level than other

Onset and cause of squint

If the squint is suspected, then it is necessary to evaluate the baby at the earliest. Sometimes a “Pseudo Squint” may be present due to a wide gap between the eyes, flat nose bridge where the eyes do appear misaligned but do not actually have the squint. The causes are:

  • Congenital Squint- These children are born with a squint though it may not be obvious for few weeks. A strong family history could be present. In all children, the vision and need for spectacles have to be assessed.
  • Long Sightedness or Hypermetropia- As the child cannot focus well, he has to put extra effort to focus, which can cause a double vision. To avoid this, the image in one eye is suppressed unconsciously and in turn, the child avoids using that eye. If left untreated not only does the eye deviate but also becomes a lazy Eye (Amblyopia)
  • Childhood illnesses- Squint may also develop because of viral fever, measles, meningitis etc.
  • Injury to the nerves
  • Hereditary

What are the Symptoms of Squint/Lazy Eye?

The most apparent symptom of a squint is that one of your child’s eye may turn upwards, downwards, inwards or outwards. Squints may not be constant. Also, a minor squint may not be obvious. Squints could cause double or blurry vision; however, kids may not be able to realize that it is a problem.

How is the Squint Treated?

Squints should be treated early so that it is most effective. Different types of treatments are available including use of glasses, eye exercises and surgery of the eye muscles.

Most patients, however, require surgical correction. Surgery is done under general anesthesia in children and under local anesthesia in adults.

The aim of the surgery is to tighten or loosen specific eye muscles required to realign the eyes. This is planned for both eyes simultaneously or on one at a time depending on the fitness for the procedure. Occasionally alignment is not achieved with the first surgery and additional surgery is needed.

The eye muscles are situated outside the eyeball and the procedure involves working on the white portion of the eyeball. The eyeball itself is not opened.

The principle of surgery is to weaken the stronger muscle and strengthen the weaker muscle. Either one or several muscles may be operated upon, depending on the type and severity of squint.

Eye is bandaged for one day after surgery.

After surgery, eye drops are prescribed and follow up visits advised.

The treatment does not stop with surgery. Glasses may have to be continued to maintain clarity of vision. Patching therapy may be needed to be continued for some time after the surgery.

With early detection, accurate diagnosis and proper treatment, the prognosis with strabismus is excellent.

Will more than one Surgery be required?

It is not uncommon for more than one operation to be necessary. This does not mean that something has gone wrong but that fine-tuning is needed to obtain the best straight alignment. Sometimes the Squint is too Large and second surgery can be planned.

Will straightening my eyes after all these years cause me to see double?

Double Vision may occur after straightening eyes that have been out of alignment for many years. However, it is generally a transient problem, lasting only a few weeks until the brain adapts to the new eye Position.

What happens after the Operation?

It is a day Care Surgery with no hospitalization. The eye pad is removed the next day and eye drops are instilled a couple of times during the next weeks. Since it is an external surgery there is no effect on the vision. Most of the times external sutures are absorbable and do not have to be removed. Though the eyes may be red initially but a person can join back his work in a couple of days.

Few of our patients’ pre and post squint surgery

Surgically treated exotropia

Surgically treated vertical squint

Accommodative Esotropia treated with glasses

Surgically treated esotropia

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