Strabismus or Squint

Strabismus or Squint refers to eyes that are misaligned and point in different directions. It may always be noticeable, or it may come and go. The eyes may cross in, drift outward, or one eye may be higher than the other. When the eyes are misaligned, two different pictures are sent to the brain.

In a young child, the brain learns to ignore the image of the misaligned eye. This causes loss of depth perception and binocular vision, and often “lazy eye” (amblyopia) results. Adults with misaligned eyes usually have double vision. As a child gets older, the chance of developing normal sight and binocular vision decreases. Most strabismus starts in childhood and often there is no clear cause.

Strabismus can run in families, and it is NOT outgrown. Strabismus is a vision development issue and not just cosmetic. Depending on the cause and type of eye misalignment, glasses, patching, eye drops, prisms or surgery may be recommended.

Causes of Strabismus most childhood squint is caused by a failure of development of normal eye movement control, and the underlying problems are still not fully understood. Squint can also be caused by problems with the nerves controlling the muscles that move the eye (e.g. ocoulometer nerve paresis, Duane Retraction Syndrome), or by diseases that affect the extra-ocular muscles themselves (e.g. thyroid disease). Blurred or poor vision due to cataract, corneal scars, glaucoma, refractive errors, optic nerve disease, retinal disease, tumors of the eye etc.

A common misconception that exists among many people little can be done to treat these problems, or that surgery will be ineffective. Excellent surgical results are possible in almost all patients who had childhood eye misalignment, whether or not you have had previous surgery. An eye may turn outwards years after in-turning eyes were corrected. Some patients still had large residual misalignments despite previous surgery. Not only will you find that people cannot tell where you are looking as you talk to them, but it is likely you will be experiencing discomfort and many difficulties focusing effectively.

Surgery usually corrects these problems. Some types of strabismus can be treated with glasses, and some do not require treatment, but most forms of strabismus will not improve without surgery. A majority of patients are able to be managed with a single operation, but some patients require more than one procedure.

Symptoms:

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  • Eyes that look misaligned.
  • Eyes that do not appear to move together.
  • Frequent blinking or squinting, especially in bright sunlight.
  • Tilting head to look at things.
  • Faulty depth perception.
  • Double vision.
  • Poor vision in one or both eyes.

Diagnosis The evaluation for suspected strabismus usually includes a medical and ophthalmic history and a test for visual acuity .The most common visible sign of Strabismus is that the eyes do not appear straight. Sometimes, a child will squint or close one eye in bright sunlight. They may tilt their heads in a specific direction in order to use their eyes together. The diagnosis of strabismus is best made with a careful eye examination with the ophthalmologist or Orthoptist.

Strabismus in children can interrupt the development of normal binocular vision, and can cause a cosmetic defect that may affect their social development. Strabismus acquired in late childhood or adulthood often causes double vision. It is important to consult an Ophthalmologist if your child displays these symptoms to determine the appropriate treatment.

Treating Strabismus:

The primary goal of treatment is to preserve or restore as much visual function as possible.
Strabismus treatment depends on the cause of the misalignment and your unique needs. This may include eyeglasses (with or without prism) or patching. Some conditions may self-correct with these treatments. If this treatment is ineffective, strabismus surgery may be performed to strengthen or loosen the muscles that move the eye.

Insight Eye clinic is among only a few clinics in the Pimple saudagar, Pimpri-chinchwad area skilled at performing strabismus surgery for both adults and children.

Non-surgical treatment – Spectacles and Prisms some squints are caused by refractive errors (spectacle powers). In such cases, squint can be corrected by prescribing proper spectacles.

In children, eye patch may be prescribed for the stronger eye to force the use of the weaker or suppressed eye. Exercises may be prescribed to strengthen specific eye muscles. In adult patients double vision caused by small squints can be corrected by incorporating prisms in the spectacles. Most patients, however, require surgical correction.

Strabismus Surgery 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. The eye muscles are situated outside the eyeball and the procedure involves working on the white portion of the eyeball. Occasionally alignment is not achieved with the first surgery and additional surgery is needed.

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. Treatment before age 8-9 years and especially by 6 years of age gives the best results.

Preventive measures Children should be monitored closely during infancy and the preschool years to detect potential eye problems, particularly if a relative has strabismus. Early detection, accurate diagnosis, and proper treatment can cure strabismus. It is recommended that all children be screened for eye health before age 6 months and again between 3 and 5 years of age by a pediatrician or an ophthalmologist.

Am I too old to have surgery for my misaligned eyes?
No! Eye muscle surgery to straighten the eyes can be performed at any age. Many adults with misaligned eyes have been told that “nothing can be done” or that the procedure in adults is “purely cosmetic.” This is incorrect. It has been shown that strabismus surgery in adults has many indications: elimination of double vision, improvement of 3D vision, expansion of visual field, elimination of abnormal head posture, and improvement of psychosocial function and vocational status.

Will my child outgrow his/her eye misalignment?
No, a child does not outgrow this condition. The earlier that it is detected and treated, the better chance for development of normal vision into adulthood.

I think my child’s eyes are crossed or drifting, but I am not sure/I do not see it all of the time. Should he/she be checked?
Yes! Sometimes it is difficult to tell if the eyes are truly deviating, so it is important to have a full evaluation by a paediatric ophthalmologist.