Patient Guide

Squints (Strabismus)

What is a Squint (Strabismus)?

When looking at an object, a normal person has both eyes pointed straight at it. If only one eye is looking straight and the other eye is turned away, then that person has a squint.

What does a squint look like?

A large squint is easy to spot. Your child may look cross-eyed, with the eye turned towards or away from the nose. Or you may mistakenly feel that your child is not looking at you because one eye is pointed away. Sometimes squints are noticed because on a photograph, the ‘red eye’ reflection of the flash is not centered in both eyes.

A small squint however, is hard to detect and only special testing by an eye specialist can pick up such squints. As even a very small squint can damage your child’s eyesight, all young children should have their eyesight tested regularly even though they appear normal.

How does a squint affect my child?

An eye with a squint may not be able to see clearly. This weak eye is called a lazy eye. A lazy eye can only be cured if detected and treated early. The earlier the treatment, the better the child will see.

A person with a squint can only use one eye at a time, whereas a person with properly aligned eyes will be able to use both eyes to judge distance and depth more accurately. This may affect the choices in your child’s future career and sports, especially those that need good binocular vision.

A squint affects the appearance and self-confidence of your child. It also affects communication. Hence, it is sometimes desirable to operate on the child’s squint at an early age. Some squints need early surgery and some cases can be deferred for a few years.

Lastly, an eye with a squint may have other conditions which need treatment. For all these reasons, any infant or child with a squint should be examined by an eye specialist.

What causes a squint?

There are many causes. It may be due to a disorder of a part of the brain controlling eye movements. It may be caused by refractive errors (degree), focusing problems, or nerve injuries. Also, any eye with poor sight tends to squint.

How is a squint treated?

A child with a squint needs a full eye checkup. This may take some time as young children are often uncooperative, though on rare occasions, the child may need to be sedated. In a baby, it is often helpful to time feeds so that the doctor can examine him during feeding. Even then it may still be necessary to come back another day to confirm the findings.

Treatment often involves spectacles to correct any refractive error. This may cure some types of squint, but to be effective, the spectacles must be worn most of the time. Children often do not understand this, so it is the responsibility of the parents to make sure they wear their spectacles constantly. 
Any lazy eye must be treated. The most effective method is to cover the good eye with a patch so that the child is forced to use the lazy eye. Adequate treatment of lazy eye improves the results of surgery.

Lastly, the eyes must be straightened to improve the appearance and to allow the child to use both eyes together. This is usually done by surgery.

How does squint surgery work?

Squint surgery is an operation on the muscles that move the eye. The eye is straightened by tightening or loosening of these muscles. Sometimes both eyes need to be operated upon but this is acceptable as this is a very safe operation and there is hardly any risk to the eyesight.

Will the operation be successful?

Yes. Most will show an improvement in their appearance. However, roughly one in five will need a second operation to obtain perfect alignment. Some will become able to use both eyes together and improve their judgement of depth and distances. The degree of success depends on factors such as the type and size of the squint and the presence of good vision in both eyes.

What are the risks of surgery?

This is a minor operation. Life-threatening or blinding complications are very rare. Your child will be put to sleep under general anaesthesia, but this is very safe if your child is healthy. Sometimes double vision may occur after the operation, but this usually disappears without treatment after a few months.

How long will my child take to get well?

The operation is done as a day surgery. The child can usually go back to school after a week or less. The eye will be red for a few weeks up to as long as a few months. There is little or no pain after the operation. The eye is not patched and your child can go back to normal studies and play after a few days. Swimming should be avoided for a month.

Does it run in the family?

Most people with squints do not have affected relatives and are of normal intelligence. However, since it occasionally run in families, it is wise to check the rest of your children if a family member has a squint.

Summary

A squint is a common condition affecting young children that may affect their sight, appearance and confidence if not detected and treated early. Every child should have his eyes checked regularly. The treatment of a squint is safe and effective but needs the full cooperation of the parents.

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