Posted on October 25, 2017
Squint or strabismus is a misalignment of the two eyes where the eyes do not look in the same direction. That is, one eye may not focus on an object someone is looking at. When the patient is looking straight ahead, the other eye may turn either inwards, outwards, upwards or downwards.
This misalignment may be constant, or it may appear sometimes. Squint is commonly seen in children but may be present in adults also. Most squints in young children may be associated with weak eyesight. Squints that develop in adults are usually due to secondary causes like trauma, lesions in the brain, etc. and their management is different from those in children. Typically, children with squint learn to suppress the image from the deviating eye, while adults report a double vision or diplopia.
The correction of squint does not happen on its own, and its treatment must begin as early as possible for best chances of improvement.
Squint treatment for children can include muscle exercises, use of prisms in spectacles and surgery to correct squint, in various combinations. Amblyopia therapy may also be required in cases with lazy eye, where the vision in one eye is poorer than that in the other.
We don’t know what exactly causes squint but an imbalance of the eye muscles can be caused by either decreased vision in one eye, or an aberration in the nerve supply. In case the squint is associated with poor vision, or amblyopia, the vision has to be corrected by amblyopia therapy.
The first step in squint correction is the prescription of glasses. After the glasses have been worn, the doctor reassesses the squint. In case of amblyopia, or lazy eye, the doctor will advise patching of the good eye according to an age-based schedule. Some doctors prefer to penalise the good eye with dilating drops. Both these techniques force the eye with weaker vision to see better and have been proven to be effective in children, especially less than eight years of age.
Some doctors may prescribe prims, which are a special kind of glasses, especially in cases with small deviations.
The doctor may also advise eye exercises to strengthen the eye muscles. These can be hospital-based, on a machine called the synaptophore, or to be done at home.
In case surgery is required, the doctor will discuss with you the sequence and planning of surgery. Sometimes, surgery on one eye is adequate, while in case of large deviations, surgery on both eyes may be required.
The doctor will also discuss with you the possibility of needing more than one surgery for optimal cosmetic and functional results. The possibility of the squint recurring at a later date, and of partial correction may also not be ruled out. Especially in cases with uncorrected amblyopia, these are more common. Very seldom, an overcorrection may happen, that is, there might be a squint in the direction opposite to the one that existed.
These complications are, however, rare. Most squint surgeries result in an optimal cosmetic result.
In adults, the management of squint is different. In case it is a squint of a long duration, the doctor will attempt a trial of amblyopia therapy after prescription of glasses. The results of amblyopia therapy in adults are not as encouraging as in children, but most patients benefit significantly from the prescription of glasses.
For sudden onset squint, your doctor will look for a cause, which is usually a paralysis of one or more of the eye muscles. He or she may prescribe imaging tests to rule out a problem in the brain, or the back of the bony orbit.
Usually, doctors prefer to wait for the spontaneous resolution of sudden onset squints. In case of intractable diplopia or double vision, you may be advised to patch the deviating eye. Sometimes, in case the diplopia persists, the doctor may suggest special glasses with prisms to provide relief.
In case the squint persists beyond the acceptable time period, the doctor will advise surgery to correct the deviation and diplopia, as in childhood squints.
Overall, it must be kept in mind that the treatment of squint hinges on three strategies:
- Restoration and correction of vision with glasses and amblyopia therapy, where ever needed
- Correction of deviation for cosmetic reasons
- Correction of deviation for functional reasons, that is preservation and restoration of binocular vision.
- Prevention of diplopia
An early intervention and compliance with the doctor’s advice regarding glasses and amblyopia therapy can result in correction of the problem with wonderful cosmetic and functional results.
The Eye7 group of hospitals has a dedicated team of super specialists including strabismus specialists and neuro-ophthalmologists to take care of squint, and state of the art equipment for both, diagnosis and treatment of the disorder.