Squint (strabismus)

A squint is the common name for 'strabismus' which is the medical term used to describe eyes that are not pointing in the same direction. Squints are also sometimes called 'lazy eye' or 'cast' according to the direction of the turn of the eye.

The squint may be present all or only part of the time, in only one eye or alternating between the two eyes. A squint can occur for a number of reasons:

Refractive (focusing) abnormality
Eye muscle imbalance
These separately or together cause squint.

It can run in families
Illness - can make it obvious
Injury
Rarely, it can be due to other diseases or illness.
Treatment of squints is different for adults and children

'Cross-eyed'/'Boss-eyed' - This is the common tern for estropia, or convergent squint, where one eye is turned in towards the centre. This is the most common form of squint.

'Wall-eyed' - This is the common term for exotroia, where one eye turns out away from the centre of the face.

Eye turned up - The medical term for this is hypertropia (vertical). This is where one eye turns up towards the forehead

Eye turned down - This is know as hypotrpia (vertical), and one eye turns down towards the cheek.


In Eye Speciality Hospital, we have a pediatric and stabismus clinic which is specialised in the treatment of strabismus (deviated eyes) in both children and adults, amblyopia (known as "lazy eye"), blinding retinal diseases of premature babies, congenital cataracts, blocked tear ducts, and pediatric neuroophthalmologic disorders. Special care is given to provide a friendly atmosphere for children undergoing examination. . Strabismus (crossed eyes or eyes that turn out) is a misalignment caused when one or more of the six muscles controlling the eyes fail to work properly. It prevents the eyes from working together, initially causing vision impairment, double vision or faulty depth perception. Strabismus occurs in two to five percent of all children. Unable to outgrow it, children may lose vision in one eye, which then succumbs to amblyopia, if the root cause is not treated in early childhood.

Diagnosis

Traditionally, ophthalmologists diagnosing children with strabismus and/or amblyopia alternately block vision of each eye, a process that annoys and distresses young patients. In our hospital, new techniques are being used that make diagnosing these disorders much easier, the ophthalmologist can determine within seconds whether the child's eyes work together normally or whether the child shows signs of strabismus.

Treatment

Treatment of strabismus usually involves glasses, eye muscle exercises and/or surgery. One conventional treatment for amblyopia has been to place an adhesive patch on the good eye, there are also another methods, such as drops or special glasses, simply to blur the good eye temporarily, thereby strengthening the weaker eye. Children are much more receptive to such methods, so better results are achieved, with minimal psychological trauma. The best outcomes result when people are treated early in life, but adults with strabismus also can have their eyes straightened. Treatment can eliminate double vision or eye strain, enlarge the field of vision or simply restore normal appearance. If surgery is necessary, our doctors can realign the eyes with a technique rarely used in young patients. Using this technique, known as adjustable sutures, the surgeon can fine-tune the eyes into exact alignment several hours after surgery is completed, much like aligning the headlights of a car. Some types of strabismus now can be treated with a new drug instead of surgery. The drug temporarily weakens muscles. Injected into the stronger of a pair of muscles, it eases the pull, allowing the weaker muscle to gain strength. When the drug wears off in about two months, proper muscle balance and eye alignment often are restored.

Squint ( strabismus ) surgery is considerd an easy surgery with very high success nowadays, it's a day case and patient can go home few hours after the operation,
eyes may still looks somewhat red for few days and this is normal, after few days every thing should be fine.

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Questions asked by the patient :

Amblyopia -Other Names, Lazy eye


What is amblyopia?
The brain and the eye work together to produce vision. Light enters the eye and is changed into nerve signals that travel along the optic nerve to the brain. Amblyopia is the medical term used when the vision in one of the eyes is reduced because the eye and the brain are not working together properly. The eye itself looks normal, but it is not being used normally because the brain is favoring the other eye. This condition is also sometimes called lazy eye.



How common is amblyopia?
Amblyopia is the most common cause of visual impairment in childhood. The condition affects approximately 2 to 3 out of every 100 children. Unless it is successfully treated in early childhood, amblyopia usually persists into adulthood, and is the most common cause of monocular (one eye) visual impairment among children and young and middle-aged adults.



What causes amblyopia?
Amblyopia may be caused by any condition that affects normal visual development or use of the eyes. Amblyopia can be caused by strabismus, an imbalance in the positioning of the two eyes. Strabismus can cause the eyes to cross in (esotropia) or turn out (exotropia). Sometimes amblyopia is caused when one eye is more nearsighted, farsighted, or astigmatic than the other eye. Occasionally, amblyopia is caused by other eye conditions such as cataract.



How is amblyopia treated in children?
Amblyopia treatment is most effective when done early in the child's life, usually before age 7. Treating amblyopia involves making the child use the eye with the reduced vision (weaker eye). Currently, there are two ways used to do this:


Atropine
A drop of a drug called atropine is placed in the stronger eye once a day to temporarily blur the vision so that the child will prefer to use the eye with amblyopia. Treatment with atropine also stimulates vision in the weaker eye and helps the part of the brain that manages vision develop more completely.
Patching

An opaque, adhesive patch is worn over the stronger eye for weeks to months. This therapy forces the child to use the eye with amblyopia. Patching stimulates vision in the weaker eye and helps the part of the brain that manages vision develop more completely.



Can amblyopia be treated in adults?
During the first six to nine years of life, the visual system develops very rapidly. Complicated connections between the eye and the brain are created. We do not yet have the technology to create these eye-to-brain connections in older children and adults. Scientists are exploring whether treatment for amblyopia in older children and adults can improve vision.



Pediatrics
For children, good vision is extremely important because it is so intrinsically involved with learning and development. Regular eye examinations are important to maintain proper eye health, even if your child does not yet speak and since some serious eye disorders produce no early warning symptoms. Although prevention is the best defense, eye problems or injuries still can occur suddenly and unexpectedly. And when they do, recognizing their signs and symptoms and knowing what to do is vital to preserving your child's vision.

Any of the following signs or symptoms suggest your child has a serious eye problems. If your child experiences any of the following, see an ophthalmologist as soon as possible.


Other common conditions related to Pediatric ophthalmology :

Congenital cataract
In which there is cataract since birth or early infancy, these cases if not treated early it will lead to severe amblyopia, also cataract my be present in childhood with or without the association with some systemic diseases, in eye specialty hospital , a specialised Pediatric ophthalmologist deals with these cases.

Congenital glaucoma
As we mentioned in glaucoma clinic, it may be present in early life and cause much damage to the eye if not treated early, (see glaucoma clinic) in our hospital, Pediatric ophthalmologist deals with such cases.

Also there are some conditions in children like lid surgery, probing and syringing of the obstructed tear passages, corneal grafting ..etc. all are refeared to the specialist in Pediatric ophthalmology and strabismus in our hospital to deal with such cases.
 

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