Squint : is it merely a cosmetic problem or a sight stealing condition ?

Squint is a misalignment of the eye where the two eyes are pointed towards different directions. 4 % of the children have squint. The misalignment may be constant or intermittent and the deviation may be in any direction inward, outward, upward or downward. Is it not merely a cosmetic problem, it is a silent thief of sight.

What are causes of squint?

Any of the following reasons may lead to Squint:

1. • Inherited from parents or previous generations
   

2. • Weakness of eye muscles or problems in the cranial nerves
   

3. • Blurred or poor vision due to cataract, corneal scars, refractive errors, optic nerve or retinal disorders

What are the clinical features of squint or how does squint manifests itself?

1. • Misalignment of one or both eyes
   

2. • Defective vision in one or both eyes
   

3. • Face turn or head tilt
   

4. • Child sometimes experiences double vision or confusion

At what age a child needs to be referred if a squint is detected?

As soon as squint is detected in a child either by parents or pediatrician he /she needs to be referred to a pediatric ophthalmologist. Even if a suspicion of squint is there it should be cleared without any delay. As shown in the above picture squint can lead to loss of binocularity or permanent loss of vision ( Amblyopia).

How can squint be managed?

Squint can be managed using combination of any of following techniques (4 O):

1. • Optics (correction of refractive error)
   

2. • Occlusion ( to correct amblyopia)
   

3. • Orthoptic exercises
   

4. • Operation (squint surgery to align eyes)

Surgical treatment is given to a child based upon the improvement in vision by spectacle and patching therapy. It also depends upon the age of the patient and the angle of deviation. Extra-ocular surgery is done on extra-ocular muscles under general anesthesia. Surgery is done on one or both eyes simultaneously depending on the deviation. Extra-ocular muscles are either weakened or strengthened (see picture below) for straightening the misaligned eyes.

Ideal age for surgery: Once the amblyopia (Lazy Eye) is treated surgery should be done as early as possible . 1 year or above is a pretty good age to take the child for surgery.

Benefits of early surgery:

1. • More chances of regaining the binocularity.
   

2. • More chances of stereopsis
   

3. • More chances that the eyes will maintain the alignment.
   

Remember: As the child grows older it becomes more difficult to treat squint and regain the lost vision. However, cosmetically straightening the eye is possible at any age.