Squint is the common name for ‘strabismus’ which is the medical term used to describe eyes that are not pointing in the same direction. A squint can be convergent (esotropia), divergent (exotropia) or vertical.
The most obvious sign of a squint is one eye that does not look straight ahead but turns inwards, outwards, upwards or downwards.
Minor squints may be less obvious.
It is quite normal for the eyes of newborn babies to ‘cross’ occasionally, particularly when they are tired. Speak to your GP if you notice this happening to your child after the age of three months.If your child looks at you with one eye closed or with their head turned to one side, it may mean that they are experiencing double vision and could be a sign that they have a squint. See your GP as soon as possible if this happens repeatedly.
If a squint is left untreated, lazy eye (amblyopia) can develop. The vision in the affected eye gradually deteriorates because the brain ignores the weaker message being sent from that eye. It is not usually possible to correct amblyopia after the age of about 7 years, which is why it is so important to treat a squint as soon as possible.
There are a number of causes. The main ones are:
These separately or together cause squint.
Some babies may appear to have a squint when they do not in fact have a true squint. This is because some small children have a wide bridge to their nose, which makes the eyes appear to be turning in. This is sometimes termed ‘epicanthus’. Epicanthus does not exclude the possibility of a squint being present and so you should always seek an expert opinion if you are concerned.
About 2-3% of the population have a squint.
No, the earlier the better.
Yes:
Yes, because squint can run in families.
Treatments include glasses and, occasionally, eye exercises. If your child has a lazy eye, they may need to wear an eye patch to improve the vision in the affected eye. Many patients may only need the condition monitoring reqularly.
In some cases, corrective surgery may be undertaken, most commonly to improve the appearance of the eyes, but sometimes to correct double vision or, in young children, to try and develop the co-ordination of the two eyes to work together for 3-D (depth) vision. Occasionally, surgery is done to improve an abnormal position of the head.
Squint surgery is a very common eye operation. It usually involves tightening or moving one or more of the outside eye muscles which move the eye to change the eye position. These muscles are attached quite close to the front of the eye under the conjunctiva, the clear surface layer. The eye is never taken out of the socket during surgery. Stitches are used to attach the muscles in their new positions.
Squint surgery is nearly always a day-case procedure, so you should be in and out of hospital on the same day. There are two kinds of squint operation - adjustable and non-adjustable. In adjustable surgery, which can be performed in older children and adults, the stitches can be adjusted shortly after the surgery, when the patient is awake.
Risks from surgery are rare, but there can be unpredictability in the exact position of the eyes after surgery and sometimes more than one operation will be needed.
Occasionally, squints corrected during childhood reappear in adulthood. You should visit your GP as soon as possible if you develop a new squint.
The first step is to give glasses if there is a significant refractive error and this may also improve the squint. Patching or atropine drops are used to treat amblyopia if present Squint surgery can be used to improve the appearance of the eyes and in some children can restore some binocular function if done early.
This is decided by the Ophthalmologist (the eye surgeon responsible for the management of your child’s squint) after refraction.
Refraction involves your child first having some drops or ointment to both eyes to dilate the pupils (make them bigger) and stabilise the focussing. Then the doctor measures what lens is needed by shining a special light into the eye and seeing how its reflection is changed. Appropriate lenses are put into a (trial) frame and older children will read the test chart.
Yes, unless advised otherwise.
You will be given a prescription for glasses which you can take to your own optician or you can visit the spectacle department on the ground floor of the Richard Desmond Centre where they specialise in children’s care and hold a good selection of frames at competitive prices. The prescription issued after a private consultation is not an NHS voucher.
These days all children have glasses with plastic lenses. These are lighter in weight and less likely to break.
Patching purely improves vision by making the brain use the amblyopic eye. The unpatched eye will appear to be straight while the patch is worn. Sometimes when the patch is removed the squint may be temporarily more noticeable, but later returns to the pre-patching position.
Possibly, if your child is less than about 8 years and if the vision in one eye is reduced because of the squint. This will mean regular follow up visits.
On the straight eye so that the eye with the poorer vision is used on its own for some part every day. It is a very effective way of improving vision.
Yes, the patch should be worn on the face. It is made from non-irritating material to prevent rashes. Spectacles are worn over the patch.
This varies according to the child’s need and may be from less than 1 hour to a day to all day. Close work activities such as colouring, reading or schoolwork should be undertaken during patching. It can be useful to negotiate this with your child’s teacher. It is important that the child is involved in some near vision activity during patching. This will achieve maximum effect and help the child comply with patching because it distracts attention from the patch. Perseverance with patching is vital.
Another way of getting a lazy eye to work is putting Atropine into the good eye to blur the vision and make the weaker eye work harder.
They can hep to control some intermittent squints in older children.
Many children with squints do need an operation as well as glasses or patching. The operation is confined entirely to the surface of the eye. The muscles which are attached to the outside of the eye are moved to a new position on the surface of the eye. Usually the muscles of the squinting eye are operated upon, but sometimes it may be necessary to operate on the muscles of the other eye as well, as this may give better results. Often one operation is effective but some children will need further operations. Even an operation cannot ensure perfect alignment afterwards. In any squint surgery the focusing parts of the eye are never operated on and there is no significant risk of your child’s sight being damaged by the operation. For any eye operation the eye is NEVER brought onto the cheek for surgery.
You may wish to visit the Childrens ward before the hospital admission. On the day of admission your child will be seen by the your surgeon and the anaesthetist (the doctor who puts your child to sleep for the operation). One parent is allowed into the anaesthetic room until the child is fully asleep.
Before returning home, the nurse will clean around the child’s eye and instil drops. The doctor will see your child and ensure they are fit for discharge. An appointment will be made for follow up after this. Usually drops will need to be used at home. The nursing staff will show you how to instil drops.
This includes time with the consultant, assessment by an orthoptist if required, and a visual acuity assessment.
If further outpatient tests and investigations are required, they will be charged at an additional rate. Your consultant will discuss this with you at your consultation.
The cost of onward treatment will be provided after initial consultation, based on your personalised treatment plan. Indicative costs are approximately:
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