Squint Problems

Category Pediatric Ophthalmology

What is Squint / Strabismus of Eyes?
Misalignment of eyes is called strabismus, or squint, and can lead to disruption of the visual development process. It can occur in children or adults. At Eye Care Dr. Anju Gupta, we provide consultation and treatment for children and adults with a squint (eye muscle problems). In the clinic, we approach each patient with special attention and assess the problems for appropriate diagnosis and treatment strategies.

How does strabismus cause poor vision?
When the eyes are oriented in different directions, the brain receives 2 different visual signals. To avoid double vision, the brain may ignore the image from the misaligned eye, resulting in poor vision development of that eye. Also, an eye that sees poorly may become misaligned, perpetuating this cycle.

What causes strabismus?
Most strabismus is the result of an abnormality of the neuromuscular (including the brain) control of eye movement. A problem with the eye muscles or glass power or poor vision may also cause strabismus. Also, an eye that sees poorly may become misaligned, perpetuating this cycle.

How do children develop squints?
Strabismus often occurs in children who are otherwise completely normal, without any family history of squint or glasses. Strabismus may also develop in children with uncorrected refractive errors, amblyopia, or cataracts. Children who are premature, have disorders such as cerebral palsy, Down syndrome, hydrocephalus, and brain tumor are more likely to develop strabismus. Children with a family history of strabismus may also develop it.

How do adults develop Strabismus/ squint?
Stroke or systemic conditions like diabetes can cause strabismus in adults.
Trauma (to the brain or eye), neurological problems like myasthenia gravis, and thyroid eye disorders are other common causes of strabismus. Older children and adults with recent-onset squints usually present with complaints of double vision.

What are the common types of Strabismus?
The two most common types of strabismus are esotropia, where an eye turns in, and exotropia, where an eye turns out. It gives the person a “cross-eyed” appearance. A problem affecting any of the six extraocular muscles, or the muscle’s nerve supply, in either eye will cause misalignment. Misalignment results in a problem in binocular vision. Special patterns of strabismus can have unique names such as Brown syndrome, and Duane Syndrome.

What is the management of strabismus?
Treatment options are non-surgical or surgical. Non-surgical options for Strabismus include the use of spectacles, prisms, eye exercises, or vision therapy and patching. Botulinum toxin injection can be used in some cases. Surgery for Strabismus is performed on the extraocular muscles in an attempt to give binocular single vision, to relieve double vision, or to cosmetically restore the eyes to their regular state of alignment.

What is the best time to perform surgery for strabismus?
The optimal time for surgical intervention is as early as possible. In case of associated amblyopia or cataract, it is recommended to treat it prior to surgery to improve the long-term success rate of eye alignment. Both the parent and surgeon have to be committed to regular follow-up and prolonged management to obtain good alignment.

How is strabismus surgery done?
The type of surgery, amount of surgery, number of muscles, and which muscles will be operated on is dependent on the type and amount of deviation. The aim of strabismus surgery is to adjust the muscle tension on one or both eyes in order to pull the eyes straight. One or both eyes may be operated upon. During surgery, a small incision is made within the tissues covering the eye to allow access to the eye muscles which are adjusted. The incision is closed with microscopic stitches which are absorbable.

Squint surgery is performed by hand and not by laser unlike other eye surgeries for cataracts and refractive error. Despite a thorough clinical evaluation and good surgical technique, the eyes may be closely aligned after surgery, but not perfect. The final alignment is dependent upon the coordination between the eye and the brain. Sometimes patients may require the use of prisms or glasses and exercises following eye muscle surgery. Over-corrections or under-corrections can occur and further surgery may be required as a child grows older.

Does strabismus surgery require anesthesia?
General anesthesia is required in children. Most adults may prefer local anesthesia.

What is the recovery time of Strabismus surgery?
Recovery time is rapid and the patient is usually able to return to normal activity within a few days. Frequent follow-ups are required within 1-2 weeks of surgery and then in a few months. You may have to take some antibiotics and anti-inflammatory medication for 4-6 weeks. Please don’t hesitate to discuss any questions you may have about the squint procedure with our eye surgeons.

What are the risks of strabismus surgery?
As with any surgery, eye muscle surgery has certain risks. There is a small risk of infection, bleeding, excessive scarring, and other rare complications, which can lead to loss of vision.

What is Esotropia?
Esotropia is a form of strabismus (eye misalignment) characterized by an inward turn, i.e towards the nose, of one or both eyes. It may be intermittent or constant and may occur with near fixation, distance fixation, or both. The deviating eye may always be the same eye or may alternate between the two eyes.

What is exotropia?
Exotropia is another common type of strabismus. It is an outward turning of one or both eyes. Often the exotropia will occur intermittently, particularly when the child is daydreaming, ill, or tired, or focusing on distant objects.

What is Pseudo-strabismus?
Pseudo-strabismus is a common condition in which the eyes appear misaligned when in fact they are not. With pseudo-esotropia, the infant usually has a wide nasal bridge and wide and prominent lid folds. When the child looks to either side, the eye hides behind the eyelid folds or wide bridge and looks like they are crossing.
It is important to distinguish this from deviation of eyes (true strabismus) and to document proper eye alignment in these cases by an orthoptic examination. Comprehensive ocular examination and follow-up are important in patients diagnosed with pseudo-strabismus, as a small percentage of these patients will develop a true esotropia.

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