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Squint

Squint is misalignment of the eyes, where both eyes point towards different directions. The misalignment may be constant for a few, while it may be intermittently occurring for some others. The deviation of the eye may be in any direction -inward, outward, upward or downward. In children, if not treated at the appropriate time, a condition called amblyopia or lazy eye occurs, which eventually leads to maldevelopment of and therefore low vision. 

Cause

  • Heredity
  • Weakness of the eye muscles or problem with the nerves of the eye muscles. In adults, it may occur due to paralysis of cranial nerve that controls the movements of the eye, and may result from uncontrolled diabetes/hypertension, or may be a result of injury/ stroke.
  • Blurred or poor vision caused due to cataract, corneal scars, glaucoma, etc.
  • Injuries.

Symptoms

  • One eye or both eyes point to different directions.
  • Defective vision in one or both eyes.
  • Children with squint, sometimes close one eye in bright sunlight.
  • Double vision or confusion.
  • Tilting the head to look at things.
  • Poor depth perception.
  • What are the tests that may be conducted to check the squint.
  • Red reflex test in small children.
  • Assessment of vision, which may require testing using pictures or letters.
  • Assessment of any need for glasses.
  • A thorough examination to rule out the causes for squint, which may also include imaging such as CT scans and blood tests, especially in sudden onset squints in adults, in addition to an examination of the eye.
  • Assessment of the degree and type of squint.
  • Assessment of binocular vision and depth perception.

Treatment plan

There is often a misconception that a squint in a child is a cosmetic problem, and it is sufficient if it is dealt with when the child is older. However, development of vision takes place maximally till 6 years of age, and then to some extent till around 10 years of age. If an eye is squinted, that eye does not form the required connections to the brain, resulting in low vision, also known as amblyopia/lazy eye. It is therefore important that a child is treated as soon as family notices a squint. 

A sudden onset of squint in an adult can be a sign of an undiagnosed problem of the brain/ nervous system, and hence must be looked into. Sometimes, a squint is due to some other treatable disease of the eye. 

  • Corrective spectacles/ Contact lenses: A sub-set of squint can be corrected by corrective glasses or contact lenses alone. Sometimes, glasses are required for visual development, in addition to other treatment modalities.
  • Eye patches: Occlusion therapy with eye patches are used in children who have low vision as a result of squint/ high power glasses. This aims at strengthening the connections between the eye and the brain to achieve maximum vision.
  • Surgery: Surgical realignment of the eyes is a relatively safe procedure and leaves no scars in or around the eyes. It is done if the squint specialist deems it fit.
  • In a child with a constant squint and poor vision in one eye, surgery needs to be performed after vision improves in the lazy eye.
  • In an intermittent squint, surgery can be withheld till squinting occurs more than 50% of the time.
  • In adults, squint surgery is done to treat double vision or for cosmetic reasons.
  • Surgery involves repositioning of one or more of the six muscles that control the movement of the eyes, to either weaken or strengthen the muscle.
  • Children are operated under general anesthesia, while a local anesthesia suffices in most adults. Recovery is rapid, and patients are usually able to resume their normal activities within a few days.
  • Surgery is however not a replacement for glasses and patching for amblyopia therapy.
  • Botox injection may be used as an alternative to surgery, especially in cases of sudden onset paralytic squint with very distressing double vision problems. The drug is injected into a contracted muscle to temporarily relax it, and help realign the eye. The effect of the drug wears off after several weeks. Sometimes, a permanent realignment may be achieved.

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Squint

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Squint is misalignment of the eyes, where both eyes point towards different directions. The misalignment may be constant for a few, while it may be intermittently occurring for some others.

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