Overview

Squint or strabismus is a misalignment of the two eyes where the eyes do not look in the same direction. That is, one eye may not focus on an object someone is looking at. When the patient is looking straight ahead, the other eye may turn either inwards, outwards, upwards or downwards.

This misalignment may be constant, or it may appear sometimes. Squint is commonly seen in children but may be present in adults also. Most squints in young children may be associated with weak eyesight. Squints that develop in adults are usually due to secondary causes like trauma, lesions in the brain, staring computer screen for long hours, etc. and their management is different from those in children. Typically, children with squint learn to suppress the image from the deviating eye, while adults report a double vision or diplopia.

Causes

We don’t know what exactly causes squint, but an imbalance of the eye muscles can be caused by either decreased vision in one eye or an aberration in the nerve supply. In case the squint is associated with poor eyesight, or amblyopia, the vision has to be corrected by amblyopia therapy.

The child eye specialist may also advise eye exercises to strengthen the eye muscles. These can be hospital-based, on a machine called the synoptophore, or to be done at home.

In case, if surgery is required, the doctor will discuss with you the sequence and planning of the operation. Sometimes, surgery on one eye is adequate, while in case of significant deviations, surgery on both eyes may be required.

The doctor will also discuss with you the possibility of needing more than one surgery for optimal cosmetic and functional results. The possibility of the squint recurring at a later date, and of partial correction may also not be ruled out. In cases with uncorrected amblyopia, these are more common. Very seldom, an over-correction may happen, that is, there might be a squint in the direction opposite to the one that existed. These complications are, however, rare. Most squint surgeries result in an optimal cosmetic result.

In adults, the management of squint is different. In case it is a squint of long duration, the doctor will attempt a trial of amblyopia therapy after prescription of glasses. The results of amblyopia therapy in adults are not as encouraging as in children, but most patients benefit significantly from the prescription of glasses.

For sudden onset squint, your doctor will look for a cause, which is usually a paralysis of one or more of the eye muscles. He or she may prescribe imaging tests to rule out a problem in the brain, or the back of the bony orbit.

Usually, doctors prefer to wait for the spontaneous resolution of sudden onset squints. In case of intractable diplopia or double vision, you may be advised to patch the deviating eye. Sometimes, in case, the diplopia persists, the doctor may suggest special glasses with prisms to provide relief.

In case the squint persists beyond the acceptable period, the doctor will advise surgery to correct the deviation and diplopia, as in childhood squints.

Overall, it must be kept in mind that the treatment of squint hinges on four strategies:

• Restoration and correction of vision with glasses and amblyopia therapy, where ever needed
• Correction of deviation for cosmetic reasons
• Correction of deviation for functional reasons, that is preservation and restoration of binocular vision
• Prevention of Diplopia

Early intervention and compliance with the doctor’s advice regarding glasses and amblyopia therapy can result in correction of the problem with incredible cosmetic and functional results.