All children suspected of a squint should be seen by an eye specialist

A squint is present when the two eyes are not pointing in the same direction e.g. one eye turns inwards, outwards or can even sit higher or lower. It may be apparent all the time or only when the person is tired or unwell, when focusing on something specific or looking in a particular direction.

Children may develop a squint due to an uncorrected focusing problem, weak use of the eyes together or there may be a family history. A squint can cause amblyopia (lazy eye) that will require glasses and/or patching therapy to improve the eyesight. A squint may also alter the way the eyes work together and cause a loss of 3-D vision (binocular vision). If the appearance of a squint is obvious then surgery is usually indicated to straighten the eye and this can also encourage binocular vision.

Adults can also have a squint, either as a long-standing problem or following a nerve palsy. The main symptom is usually that of double vision which can be managed initially with prisms. Often, a squint following a nerve palsy may recover on its own and surgery is only undertaken once the squint has stabilised.

Squints

What is a squint (strabismus)?

A squint or strabismus is present when the two eyes are not looking in the same direction. It may be apparent all the time or only when the person is tired, unwell or focusing on a near or distant object. The eye may turn in or out, or one eye may sit higher than the other. A squint may vary depending on the gaze position.

Normal eyes Left esotropia Left exotropia Left hypertropia

Strabismus

Babies often have the appearance of a squint due to a wide bridge of the nose and this appearance is lost as the face develops. However, a child with a true squint will not grow out of it, so all children suspected of a squint must be seen by an eye specialist.
Squints can also be seen in adults, as a long-standing problem or following a nerve palsy.

What causes the squint?

Squints may occur in families and may arise in the first few months of life. However, they may also appear in older children. Some children have poorly developed binocular vision (ability to use the eyes together to achieve 3-D vision) and a squint can develop. If a squint is present, the misalignment means that the eyes will lose the ability to work together and achieve 3-D vision (binocular vision).

Children may be far-sighted and have a focusing problem, in which case the effort of focusing to see clearly may lead to a squint. Glasses alone may correct this problem.

Very occasionally a child may develop a squint because there is a problem with the eye and it has defective sight. The earlier this is detected the sooner treatment can be started.

If a child squints with one eye, then the vision in that eye
will become lazy (amblyopic) as the brain ignores information from the squinting eye.

What are the effects of a squint?

• a child may develop a lazy eye (amblyopia) which
  if not treated will lead to long term poor sight in that eye
• a child will lose binocular vision
• a squint may spoil one's appearance
• in adults the main symptom is often double vision.

When should treatment start?

Children suspected of a squint should be seen without delay by an eye specialist. No child is too young to be seen. In adults a squint from nerve palsy may recover on its own and treatment is therefore only undertaken once the squint has stabilised.

What is the treatment?

Glasses will be prescribed if there is a focusing error, particularly with far-sightedness.

If a child squints with one eye only then this eye will become lazy. The other eye is patched so the child has to use the lazy eye. The aim is to improve the vision in the lazy eye to a similar level of vision as the good eye achieves. The child will then be able to use either eye to see and the squint will switch from one eye to the other (alternation) which is the aim of the treatment.

If the appearance of a squint is obvious then surgery is carried out to move the eye muscles and thereby straighten the eye. In some cases surgery is performed early in an effort to achieve binocular single vision.

In children, surgery is usually performed between the ages of six months and four years, and in adults it may be performed at any convenient time once the squint has stabilised. Squint surgery is performed as a day stay procedure under general anaesthesia.

For further information see our brochure or contact our friendly specialist team

For more information on squints please contact our friendly specialist team.