Squint Eye Specialist

Squint Examination

Squints are treated by squint specialists and Eye Solutions has the Best Squint specialist in Mumbai. They are also known as ‘strabismologists’.  Squint surgeries are one of two surgeries that Dr Garg performs.  The other is cataract surgeries.

A squint examination or Squint test is a type of examination done after a routine examination or routine eye test, to analyze the squint.

There are two things that squint specialists look for.  

• Diagnosis
• Measurement

Diagnosis of Squint

We, as squint specialists, want to be able to find out what type of squint the patient has.  There are many types of squint and it’s important to know which type the patient has.  In other words, we want to know the cause of the squint. Why has the squint occurred in a particular patient?  Does it fit a certain pattern that has already been described in our books? Some of the questions squint specialists seek answers to are

• Is the squint since birth or occurred a few years later
• Is it because of an injury? 
• Has it increased or decreased over time?  
• Is the squint constant or occur only sometimes?  
• Is the squint more when the patient is looking at near things or far things?
• Are their headaches associated with the squint?
• How is vision in each eye?

These questions don’t stop here but you get the idea…..

Measurement of Squint

After this, we want to be able to measure the squint and actually quantify the size of the deviation.  This helps in planning the surgery.

So what exactly happens in a squint test or consultation?

A squint eye test involves -

• Detailed history – Something like the questions that were posted earlier
• Vision test – we check to see how the vision is in each eye and together.  This is very important especially in children because they may develop what is known as amblyopia.  One of the causes of amblyopia is squint.  
• Refraction – Eye number check-up.  Here we check if there is a change in the number of glasses and if the vision is improving after changing the glasses
• Slit-lamp examination – Microscopic examination of the front part of the eye.
• Measurement of the squint – this is done by something squint specialists call a cover test.  We use prisms which are types of lenses that help in measuring the squint. See the video below.  You will notice that when the hand that is covering one eye is moved to the other the eye which was just uncovered moves to start seeing things in the front.  This movement denotes the presence of a squint. Prisms help us measure that deviation. 
• Sometimes the individual looks like they have a squint but may not have one.  This condition is known as pseudostrabismus or a false squint.

The measurement is done in all nine gazes and you can see in the picture below then we document these measurements as shown.  This documentation is very important to reach a decision on which muscles to operate and how much to operate them by.  

Yes, sometimes this process can take longer and can be tiring for the patient but it is one of the most important steps of a squint examination.

• Extra Ocular movements – Here we check the movements of both eyes together and each eye individually.  Sometimes in problems like Duane’s Syndrome, the movements are restricted. There could be a few causes of limitation of movements,  There could be a nerve palsy, something like a stroke, or also a congenital defect. Movement limitation could also happen after an injury to the surrounding structures of the eyes.
• Worth 4 dot test – this test again helps us in confirming the presence of double vision and how far or near are the two images.  We also learn whether the double vision is up and down apart from side by side.
  The above-mentioned points are what we do for all patients. 

Sometimes we may do a few other tests too

• Patch test – Here we patch one eye for more than half an hour and have the patient sit in the waiting room.  We then again call the patient to the doctor’s room and reexamine the patient. Sometimes this half-hour could also extend to a few hours.
• Prism Adaptation – Here we make the patients sit with certain lenses in front of them for half an hour or more in our waiting area.  We want to understand how the patient feels with these new lenses. This helps us in deciding whether we should operate or not and if yes how much surgery should we do.

Each of the points mentioned above forms part of a squint eye test.  It may take more than 15-30 minutes to do this part of the examination.  

Eye Solutions can be considered as one of the best eye hospitals in India for squint treatment because we not only have the best squint specialist in Mumbai but also pediatric optometrists, pediatric anesthetists and a team that is tuned to treat children and also assist families whose children undergo surgery.

How are squints treated?

Squints should be treated early so that it is most effective. Different types of treatments are available including the 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 one at a time depending on the type of squint and what your squint specialist is comfortable with. Occasionally alignment is not achieved with the first surgery and additional surgery is needed.  Usually, for all types of squints, we find that up to 80% of patients don’t require another surgery to correct the squint, but there is always a possibility that another surgery may be 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 or entered.

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 the squint.

Read about: Squint Surgery