Squint Service

The medical name for squint is strabismus .It is a condition where the eyes do not look together in the same direction. Whilst one eye looks straight ahead, the other eye turns to point inwards, outwards, upwards or downwards. Squints are common and affect about 1 in 20 children. You might even spot that your baby has a squint. Most squints develop before preschool age, usually by the time a child is three years old. Sometime A child with a squint may stop using the affected eye to see with. This can lead to visual loss called amblyopia, which can become permanent unless treated early in childhood. squints develop in older children, or in adults.

What Causes Squint?

A squint develops when the eye muscles do not work in a balanced way and the eyes do not move together correctly.

Yes, there are different types of squint. Squints can be divided into different categories:

  • By the direction of the squinting (turning) eye: in, out , up or down?
  • Constant or Intermittent?
  • Manifest or latent?
  • Concomitant or incomitant i.e., whether the severity (angle) of the squint is the same in all directions or not?

What are the types and causes of squint in children?

About 5 in 100 children aged five years old have a squint. It is quite common to notice a brief squint when tired or daydreaming. Babies sometimes cross their eyes - it is quite normal for this to happen occasionally, especially when they are tired. Some squints are much more obvious than others. You might notice your child has an eye that does not look straight ahead. Another sign of squint is that your child might close one eye when looking at you, or turns his or her head on one side.

  • Congenital squints of unknown cause
  • Squint related to refractive errors
  • Other Cause.

In some cases squint might be a manifestation of an underlying eye problem like In some cases, a squint is one feature of a more generalised genetic or brain condition. Squints can occur in some children with cerebral palsy, Noonan's or Down's syndrome, hydrocephalus, brain injury or tumour, retinoblastoma (a rare type of eye cancer) and several other conditions.

Amblyopia

Amblyopia is sometimes called a lazy eye. It is a condition where the vision in an eye is poor and it is caused by lack of use of the eye in early childhood. If amblyopia is not treated before the age of about 7 years, the visual impairment usually remains permanent. A squint is the most common cause of amblyopia. In many cases of squint, one eye remains the dominant focusing eye (the one that sees). The other, turned eye (the squinting one) is not used to focusing, and the brain ignores the signals from this eye. The turned eye then fails to develop the normal visual pathways in childhood and amblyopia develops in this eye.

How the squint looks

A squint can be a cosmetic problem. Many older children and adults who did not have their squint treated as a child have a reduced self-esteem because of the way their squint looks to other people. Impaired binocular vision

This means the child does not have a good sense of depth when looking at objects. As a result, he or she cannot see properly in three dimensions.

How is a squint diagnosed and assessed?

It is important to diagnose a squint (and amblyopia) as early as possible. Routine checks to detect eye problems in babies and children are usually done at the newborn examination and at the 6- to 8-week review. There is also a routine preschool or school-entry vision check.

Some newborn babies have a mild intermittent squint that soon goes. However, fixed squints are usually permanent unless treated. So, as a guide.

Any squint seen in a newborn baby should always be intermittent (come and go), reducing by 2 months of age, and gone by 4 months of age. A baby with a constant fixed squint, or with an intermittent squint that is worsening from 2 months, should be referred for assessment.

What are the treatments for squint?

Treatment typically involves the following:

  • Occlusion: Treating amblyopia (visual loss) if this is present by patching.
  • Optics: Wearing glasses to correct any refractive error, if this is present.
  • Orthoptic Exercises
  • Operation: Surgery is often needed to correct the appearance of the squint itself, and may help to restore binocular vision in some cases

Correcting refractive errors

If a child has a refractive error (long or short sight, for example) then glasses will be prescribed. This corrects vision in the eye. It may also straighten the squinting eye, if the refractive error was the cause of the squint.

Surgery

In many cases an operation is advised to make the eyes as straight as possible. The main aim of surgery is to improve the appearance of the eyes. In some cases, surgery may also improve or restore binocular vision (this means that the two eyes are working together).

Botulinum toxin

Botulinum toxin (also know as Botox®) stops muscle cells from working (it paralyses them). It is used for a variety of conditions where it is helpful to weaken one or more muscles. In recent years, injections of botulinum toxin directly into eye muscles have been used as a treatment for certain types of squint.