Squint Assessment (Strabismus)

Blurred or double vision

Squints are common disorders among young children and newborns, and may lead to a lazy (amblyopic) eye and cause self-consciousness if not treated timeously.

The management of squints starts with an examination by an orthoptist and an ophthalmologist, to determine the cause and appropriate treatment for the muscle imbalance. Realignment of the muscles is usually achieved by spectacle correction, surgery and/or nonsurgical methods (such as exercises to strengthen the eye muscles).

What is Strabismus?

Strabismus is the proper medical term for squint eyes, colloquially referred to as being “cross-eyed”.

When an individual is squint it means that their eyes at rest point in different directions.

One eye typically faces forward while the other can point up or down, left or right, or a combination of the above.

Squints are incredibly common, affecting approximately one in twenty children between the ages of naught and five.

While most squints develop by age 5, they can develop in adults, and treatment is available for children and adults alike.

How do squints affect vision?

Not only do squints affect our appearance as it is noticeable that the eyes look in different directions, but squints can also affect vision.

Squints can lead to the development of double vision, head and/or neck affectations or abnormal positioning, or even a lazy eye (otherwise known as amblyopia, in which the sight in the squint eye deteriorates rapidly due to the brain ignoring the weaker signal from this eye).

While amblyopia is treatable, seeking treatment should not be delayed.

Amblyopia in children should ideally be treated (and hopefully resolved) before the child reaches primary school age.

This in order to ensure the best outcome.

What are the different types of squints and what causes them?

Some squints are apparent from birth.

These are called congenital or infantile squints and they are considered inherent.

This means that the squint is genetic and not acquired by the individual after birth.

Acquired squints include all squints developed after birth.

For example, convergent squints (eye turns inward), divergent squints (eye turns outward), and vertical squints.

Acquired squints are often developed as a result of the eye attempting to compensate for pre-existing vision problems like nearsightedness or farsightedness.

Acquired squints can also be acute and situational, meaning that they come and go depending on the person’s circumstances, or they can be chronic, meaning they are present at all times and do not naturally improve under certain conditions.

Symptoms for Strabismus

The most obvious symptom of strabismus is the telltale “cross-eyed” appearance.

Other symptoms may include vision loss, lazy eye, headaches, neck and back aches as a result of abnormal positioning, double-vision and other vision abnormalities.

Treatments for Squints

There are a variety of treatments available for strabismus, including minimally invasive surgical and non-surgical options.

Conservative treatment and/or early intervention in children may require the child to complete daily eye exercises and result in a prescription for spectacles.

If the child has developed a lazy eye, they may also be required to wear an eye-patch temporarily or intermittently during their childhood in order to improve the vision in the lazy eye.

Sometimes, the only additional treatment required is routine monitoring to ensure the long-term preservation of the child’s eyesight.

In some cases, a minimally invasive surgery may be offered to correct the appearance of a squint.

Surgical correction of a squint improves the appearance of the eyes but may not be directly responsible for improving vision.

That being said, sometimes the surgery is attempted in an effort to correct double-vision or to improve the three-dimensional spatial reasoning in children born with strabismus by encouraging the eyes to work together.

Surgery for squints is exceedingly common and minimally invasive.

Surgery typically involves tightening or moving one or more of the muscles in the eye in order to reposition it.

Barring any complications, squint surgery is almost always considered a day-procedure, meaning you’ll be in and out of the hospital on the same day.

There are two kinds of surgery to correct squints: adjustable and non-adjustable surgical interventions.

In adjustable surgical intervention, the stitches can be adjusted after surgery, while the patient is awake, in order to perfect the eye’s alignment, which is not perfectly predictable during surgery.

In non-adjustable surgical intervention, the new position of the eye is fixed post-surgery, and as a result, more than one surgery may ultimately be performed in order to achieve the desired outcome.

The benefits of Squint Surgery

Surgically correcting squints can be curative of both the squint appearance and its associated vision abnormalities.

In rare cases, a surgically corrected squint may reappear in later life, at which point it is crucial you consult your doctor as soon as possible.

Recovering from Squint Surgery

As a day-procedure, the recovery from squint surgery is only moderately painful, and it is more likely that patients will experience an itching sensation in the eye in the days and weeks immediately following surgery.

Double-vision may be a temporary side-effect of the surgery and should correct itself within a couple of weeks.

Risks of Squint Surgery

The greatest risk of surgery is associated with general anesthesia.

The risks of strabismus surgery in and of itself include, but may not be limited to the following:

• The final position of the eye may not be ideal and a revision surgery may be required. This risk is minimised in adjustable surgical intervention, and will also vary based on the patient’s age as well as the type of squint. 
• Infection. Although uncommon, infection is always a possibility. Mild surface infections will be treated with antibiotics and/or antibiotic eye drops. Deeper, more serious infections of the surgical sight or eye are exceedingly rare. 
• Loss of sight in the eye occurs in 1 in approximately 20 000 cases. 
• Problems with wound healing. 
• Double-vision, which is typically transient and resolves on its own.

For more information on Strabismus, you can visit any of the sites listed below. Alternatively, or if you are actively seeking diagnosis and/or treatment, you can contact The Eye Centre directly to book your consultation with one of our resident ophthalmologists – because we care about eye care. Please note that we no longer perform squint surgery at The Eye Centre but we will continue to evaluate patients and make referrals to other ophthalmologists who specialise in these procedures.

Squint (Strabismus) – by Moorfields.nhs.uk

Strabimus Surgery – by All About Vision

About Squint Surgery – by The Royal Children’s Hospital Melbourne