SQUINT CLINIC
What is squint (strabismus)?
Squint is a misalignment of the two eyes where in two eyes are not looking
in the same direction.
This misalignment may be constant, being present throughout the day, or it may
appear sometimes and the rest of the time the eyes may be straight called as
intermittent squint.
What causes squint?
The exact cause of squint is not known.
Six muscles control the movement of each eye (see picture) . Each of these
muscle acts along with its counterpart in the other eye to keep both the eyes
aligned properly. A loss of coordination between the muscles of the two eyes
leads to misalignment.
Sometimes a refractive error hypermetropia (far sightedness) or an eye muscle
paralysis may lead to deviation of the eye.
Poor vision in an eye because of some other eye disease like cataract, etc. may
also cause the eye to deviate. Therefore it is important in all the cases of
squint, especially in children, to have a thorough eye checkup to rule out any
other cause of loss of vision.
What is 3D vision?
When both the eyes have good vision and they are aligned properly, they
focus on the same object. Each of the eyes sends picture of the same object,
viewed from a slightly different angle. These two images reach the brain, where
they are fused to form a single three-dimensional picture with depth
perception. This is known as 3D vision. This gets affected in children with
squint.
What are the problems faced by a patient with squint?
When the eyes are not aligned properly, each of the eyes is focusing on a
different object and sends signal to the brain. These two different images
reaching the brain lead to various problems that are different in children and
adults.
In children it can cause loss of depth perception (3D vision) and lazy Eye
Disease (poor development of vision in the squinting eye)
An adult can't ignore the image from either eye, and therefore they can have
double vision. This can be very annoying and may interfere with work. Certainly
loss of 3D vision and cosmetic deformity are also causes of concern.
What are the symptoms of squint?
In a child, the parents may notice the deviation of eyes. It is important
to remember that the eyes of a newborn are rarely aligned at birth. Most
establish alignment at 3-4 weeks of age. Therefore squint in any child who is
more than one month old must be taken seriously and should be evaluated by an
ophthalmologist.
Adults may notice double vision, or misalignment of the eyes.
How is squint diagnosed?
The squint is diagnosed by the ophthalmologist specializing in that field.
He or she would do a few special tests to confirm the presence of squint, and
find out the of the squint. In some cases there may be a false appearance of
squint due to broad nasal bridge in a child. This is called as pseudo squint.
What is the aim of the treatment for squint?
The aim of treatment of squint in order of importance are:Preserve
or restore vision
Straighten the eyes
Restore 3D vision
When should the squint be treated?
In a child, the treatment of squint and any associated amblyopia should be
started as soon as possible. Generally speaking, the younger the age at which
amblyopia is treated; the better is the chance of recovery of vision.
Remember that the child would never grow out of squint. A delay in treatment
may decrease the chances of getting a good alignment and the vision.
Earlier the better!
What are the treatment options?Glasses
Patching therapy
Surgery
Are glasses necessary?
If the child has significant refractive error, glasses are a must. In some
cases wearing glasses may correct squint. In other cases, wearing glasses help
the eyes to see clearly. This clear vision is very important for the treatment
of amblyopia, and also for maintaining the alignment of eyes after they have
been aligned by surgery. Remember surgery cannot replace the need for glasses.
What is patching therapy?
In some children, squints cause the squinting eye to become 'lazy' and stop
working properly. Patching the 'good' eye will make the lazy eye work harder,
which improves vision.
Patching improves vision it does not treat the squint, although 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.
The patch is made from non-irritating material to prevent rashes, and
spectacles are worn over the patch.
It is thought that the patching therapy works best for children below 7-8 years
of age.
How long should the patch be worn?
This varies according to the child's need and may be from less than 1 hour
a day to all day. It is important that the child is involved in some near
vision activity during patching, such as coloring, reading or schoolwork. This
will achieve maximum effect and help the child comply with patching because it
distracts attention from the patch. Perseverance with patching is vital. The
patching needs to be continued at least till the age of 7-8 years.
Squint surgery
Treatment of squint generally requires eye muscle surgery. However, some
patients may need glasses, prisms, medications, or may be best left untreated.
The best way to determine whether straightening of the eyes is possible and
appropriate, is to undergo an examination by a strabismus surgeon who is
experienced in treating adults.
Is adult squint surgery only cosmetic?
In the past, most eye doctors thought that adults with misaligned eyes
could not be treated successfully, or that treatment was "only cosmetic".
Advances in the management of misaligned eyes now provide benefits to most
adults as well as children. Treating adults with strabismus can improve depth
perception, the way the two eyes work together, and the field of vision. Many
patients report improved self-esteem, communication skills, job opportunities,
reading and driving.
What are the complications of squint surgery?
Like any other surgery, squint surgery is not without complications.
Significant complications of strabismus surgery include endophthalmitis
(infection of the eye ball) and retinal detachment, both as a result of
accidental perforation of the globe during surgery. These complications are
very rare: Perforation of the globe may occur in 0.3% - 2.8% of cases,
resulting in endophthalmitis in less than 1:3500 cases, and retinal detachment
in even fewer cases.
What are the success rates of a squint surgery?
Nearly 80-90% patients are successfully corrected in the straight-ahead
position with one surgery. In some patients the surgery may be only partially
successful. In some patients the eye alignment will change over time, resulting
in the need for additional surgery after few months or years
How is the squint surgery performed?
The squint surgery is done under local or general anesthesia depending on
the age of the patients and the complexity of squint.
The surgical technique used in our hospital is fornix incision and adjustable
technique, which is state of the art.
Feel free to ask any other queries to our squint specialist.
For more details you can Email at
paediatricophthal@adityajyot.org
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