PAEDIATRIC OPHTHALMOLOGY: SQUINT OR STRABISMUS

Squint or strabismus is a misalignment of the eyes that can result in the eyes not looking in the same direction. They may end up being either convergent or divergent in straight gaze, or one eye drifting upwards or downwards.

All squints should be referred to an Ophthalmologist (and/or orthoptist) as early as possible. A squint may be correctable at an early age simply by the use of patches or glasses. At a later stage of diagnosis non-surgical or surgical treatment may be required.

A squint may present by itself or be secondary to other less obvious conditions. Therefore, all squints need to be investigated thoroughly.

 

Causes of squint:

For some children there will be no particular cause of the squint. Other common causes include:

  • Refractive errors – where there is a problem with the focusing power of the eye
  • Eye conditions – such as congenital cataract, retinal or optic nerve conditions
  • Eye muscle problems
  • Family history.

This misalignment of the eyes is usually noticed at the end of the day and may become more evident when:

  • tired
  • whilst daydreaming
  • after drinking alcohol (adults)
  • following extensive close-up concentration.

This condition may be accompanied by double vision, headaches or blurred vision. Sometimes the squint is not noticed by the patient but by friends or family, or it is picked up on in a photograph or video.

Treatment of a squint:

Contrary to popular belief, a squint can be treated irrespective of age. Some squints can be treated with glasses or contact lenses, others with Botox and some patients need a surgical procedure for a definitive cure.

The decision for surgery differs per patient. However, with a number of advances in microsurgical skills and with improved techniques over the last few years, squint surgery is now much safer and more successful than before.

Small incision squint surgery

In some cases, surgery may be possible to correct a squint. You may need squint surgery on one or both eyes. 

Mr Jain has pioneered small incision squint surgery in the UK. By making a small incision that is hidden under the lower eyelid, there is no visible scarring. 

Surgery is performed under general anaesthetic and usually lasts around half an hour or less, depending on the number of muscles being operated on. You should be able to go home the same day. The eye will be red after the procedure, but this should fade within three weeks and you will be given eye drops to reduce inflammation and prevent infection.

Small Incision Squint Surgery Incision (green) and Conventional Squint Surgery incision (red)

Postoperative care

The eye is red following the procedure and drops to reduce the inflammation and prevent infection are supplied after the surgery; no patches or pads are needed. The redness wears off within three weeks and within this time swimming and heavy exercise are not advisable.

Children may have to stay off school for the first week; an immediate post-operative appointment is arranged within the first week and then another after a month or so.

Out of hours aftercare

Mr. Jain is always happy to receive calls if a patient is having difficulties after surgery. Call his secretary or the hospital at which the surgery was carried out and they will give him your contact details. If you have any further questions, please feel free to send us an email.

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Mr Saurabh Jain

Saurabh Jain Is a Consultant Ophthalmic Surgeon and Clinical Director of services at the Royal Free London NHS Foundation Trust.