SQUINT (Strabismus)

Strabismus or Squint (crossed eyes) is an eye problem in which the eyes are not properly aligned and thus point in different directions. One eye may look straight ahead, while the other eye turns inward, outward, upward or downward.

The Squint may be a constant feature or it may be intermittent, ie; the squint may be seen only at certain times such as when the child is tired or day dreaming, etc.

Strabismus is common among children. About 4% of all children in the United States have Strabismus. Although uncommon it can also occur later in adulthood. Strabismus tends to run in families,it occurs equally in males and females.

The exact cause of Strabismus is not fully understood. The most common childhood squints are congenital esotropia, accomodative esotropia, and exotropia. Accommodative esotropia is due to refractive error-hyperopia or farsightedness.

The main symptom of Strabismus is an eye that is not straight. Sometimes, children squint one eye in bright sunlight or tilt their head to use their eyes together.

Strabismus can be diagnosed during a detailed eye examination. It is recommended that all children should have their vision checked by a pediatician, family doctor or ophthalmologist at or before their fourth birthday. If there is a family history of Strabismus or amblyopia, an ophthalmologist should check the child’s vision even before the age of three.

An infant’s eyes often seem to be crossed. Young children often have a wide, flat nose and a fold of skin at the inner eyelid that can make the eyes appear crossed. This appearance of Strabismus may disappear or become less as the child grows. But a child will not outgrow ‘true’ Strabismus.

An ophthalmologist can usually tell the difference between true and false Strabismus.

Good vision develops during childhood when both eyes are straight. Strabismus may cause reduced vision-known as amblyopia in the weaker eye. In such a case the brain recognizes the image of a better –seeing eye and ignores the image from the weaker or amblyopic eye. This occurs in approximately half the children who have Strabismus, but have not been treated in time.

Amblyopia can be treated by patching the ‘good’ eye to strengthen and improve vision in the weaker eye. If amblyopia is detected in the first few years of life, treatment is usually successful. If treatment is delayed, amblyopia can become permanent. As a rule, the earlier amblyopia is diagnosed and treated, the better the visual result.

Treatment of amblyopia in the form of patching is a MUST for the development of vision in children with strabismus . Parents and guardians play a vital role in this timely intervention.

Treatment for strabismus works towards:

1. Preserving the vision,

2.  Straightening the eyes, and

3.  Restoring binocular (two-eyed) vision.

An ophthalmologist can recommend appropriate treatment after a complete eye examination. In some cases, spectacles may be prescribed for the child. Other treatments may involve surgery to correct the unbalanced eye muscles or to remove a cataract. Coverting or patching the strong eye is often necessary to treat amblyopia.

In any kind of eye surgery, the eyeball is never removed from the socket. The ophthalmologist makes a small incision in the tissue covering the eye to reach the eye muscles. During surgery, the doctor may reposition certain muscles, depending on which direction the eye is turning. It may some times be necessary to perform surgery on one or both eyes. When strabismus surgery is performed on children, a general anesthetic is required. Local anesthesia is an option for adults. The recovery is quite fast and most people are able to resume their normal activities within a few days. After surgery, glasses or prisms may be useful. In some cases, further surgery may be needed at a later stage to keep the eyes straight. For children with constant strabismus, early surgery offers the best chance for the eyes to work well together. In general, it is easier for children to undergo such surgery before starting school. As with any surgery, eye muscle surgery too has certain risks. These include under or over correction, transient(temporary) double vision, infection and risks related to anesthesia, as well as other rare complications that can lead to loss of vision. Strabismus surgery is usually a safe and effective treatment for misalignment of the eyes. It is not, however, a substitute for glasses or amblyopia therapy.