Squint or strabismus is a misalignment of the eyes so that the eyes do not point in the same direction (cross eyed appearance).

If untreated, squint can itself lead to

  • Amblyopia or lazy eye.
  • Loss of binocularity (cannot assess depth)
  • Lack of coordination between the eyes
  • More importantly squint if present since childhood can itself lead to loss of three-dimensional vision or depth perception (stereopsis).

Squint can itself lead to cosmetic disfigurement, in addition in children there is a risk of amblyopia. Under such circumstances, it is important that one corrects the squint early. In addition, there is a beneficial effect of correction of squint even in older adults as there is improvement in binocular vision. The simplicity and ease of surgery means some patients start work the next day post-surgery. The results are very good with a proper clinical assessment and modern techniques of surgery.

The most common types of squint are exotropia (divergent) and esotropia (convergent squint).

Convergent squint can be corrected many a times by glasses. Early correction is recommended especially in the convergent squints as there is a higher risk of amblyopia and loss of binocularity.

Divergent squint can again be corrected with glasses, but more commonly needs surgery.

Squint Surgery

Child with esotropia (convergent squint) before and after surgery showing excellent results

 A young girl with exotropia (divergent squint) before and after surgery.

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Frequently Asked Questions

The 2 images from each eye –> confusion –> suppression of one eye –> lazy eye (amblyopia)

The 2 images from each eye –> double vision

Yes, lazy eye or amblyopia needs to be treated before squint surgery is undertaken for good long term outcome.

Depending on the nature of the squint the various modalities available are

  • Optical correction with glasses
  • Prisms
  • Squint surgery
  • Chemodenervation with botulinum toxin
  • Active vision therapy
  • Pharmacological agents

The surgery is performed in such a manner that there is no visible scar of the surgery. The eyeball is never removed from the socket during eye surgery. A small incision is made in the superficial tissues above the eyeball to reach the eye muscles which are placed on the eyeball. The eye muscles are fixed externally on the eyeball. Muscles are repositioned during the eye surgery. In children surgery is performed under general anesthesia and in adults it can be performed under local anesthesia.

Recovery from surgery is very fast and normal activities can be resumed the day after surgery.

No head bath should be taken for a week after surgery and swimming should be avoided for 2 months. Avoid splashing water into your eyes. One can watch TV and read books normally without undue strain after surgery.

Squint surgery is generally very successful. Every patient is different, and surgery is planned for everyone considering various factors with the objective of a good long-term outcome. Chances of recurrence are very less with appropriate modification of technique.

Myths & Facts About Squint

FACT:  Most cases of squint need treatment in form of glasses, exercises or surgery. leaving it alone can result in permanent visual impairment in addition to cosmetic blemish.

FACT: Ideal age for any intervention for the children’s eyes is before 7 years of age, although if squint is noticed right after birth, it needs immediate attention. Severe vision loss can occur in the squinting eye if neglected.

FACT: Squint if treated at an early age doesn’t necessarily lead to visual impariment or blindness.

FACT: Most cases of squint can be effectively treated with glasses provided the intervention is the right age. Wearing glasses or having squint doesn’t equate to poor sight or eye disease

FACT: Playing sports or reading doesn’t really have any effect on the amount of squint, but delaying the treatment does impair vision.

FACT: With modern techniques of treatment, squint surgery is very successful. In fact squint surgery is amongst the most successful surgeries like cataract surgery.

FACT: In the present age, squint suregery can be performed in the very old > 70 years to the very young < 1 year.

FACT: They do not. Although the eyes are initially not coordinated, control of eye movements is achieved at approximately three months of age.

FACT: Examination of the eyes is possible in children of all ages. An experienced pediatric ophthalmologist ca easily examine children of any age.

FACT: A small squint can result in amblyopia and defective binocular vision, hence early treatment is a must.

FACT: Surgery will only alter the position of the eyes. It does not affect the eye power.

There are variety of reasons for squint and the treatment options are many. The child/adult must be carefully evaluated by the squint specialist for the best treatment option. In cases where squint doesn’t resolve on its own or with glasses, surgery is indicated for both visual and cosmetic reasons.

Dr. Ramesh Murthy is an accredited member of the American Association of Pediatric Ophthalmology and Strabismus and has been awarded the membership based on his training and experience in this field.

Every child should ideally undergo an eye examination by the age of 3 years or before entering school according to the guidelines of the American Association of Pediatric Ophthalmology and Strabismus.

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