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Squint



By Dr. Madhu Karna



What is squint ?





Squint occurs when one eye is straight and the other eye turns away form the straight position. This condition can happen at any age. The squinting eye can turn inwards (convergent squint) or outwards (divergent squint). A squint can also be vertical with one eye higher than the other.



When squint is present, will the eyes always look misaligned?





Squints can be constant, present all the time, they can be intermittent and occur in certain situations, like when the child is reading, tired or when he is looking in the distance.



What are the effects of crossed-eyes?





Children with crossed eyes may initially have double vision. When a squint is constant, three things can occur.


1) Amblyopia or Lazy Eye: When a child has a constant squint, he does not use the squinting eye to see and this will result in that eye having poor vision.


2) Poor Binocular Vision: The ability to appreciate depth or stereovision requires both eyes to be aligned so that they can be used as a pair. A child with a constant squint has no binocular or stereovision.


3) Abnormal Head Position: Some children adopt an abnormal head position like a tilt or face turn when they have a squint to try to keep both eyes aligned.



What treatment is available for squint?





Some squints can be caused by uncorrected long-sightedness (hyperopia) or shortsightedness (myopia). Glasses can sometimes reduce or completely eliminate the squint and the need for surgery. All children with squints should have their eyes checked and glasses, if prescribed, should be worn at all times to help straighten the eyes.

If the glasses do not completely eliminate the squint, muscle surgery is then needed for the remaining squint.



When surgery should be done?


Existing amblyopia must be treated first. This can be done by patching the good eye, forcing the child to use the lazy eye. When the vision in the squinting eye becomes normal, the child will use each eye equally and the squint will be noted to alternate between the eyes. Once vision is restored in the amblyopic eye, squint surgery is performed to realign the eyes and to allow binocular vision to develop. Binocular vision can only be regained when a child is young. In a child with intermittent squint, surgery is not so urgent as he experiences binocular vision some of the time. In an adult, if squint has been present for a long time and binocular vision is not possible, surgery can be done to improve his appearance.


What is false or pseudo-squint?


Some babies, appear to have a convergent squint when folds of skin cover the inner part of the eyes. If a true squint is not present after medical examination, it is called a pseudo squint and no treatment is necessary.


Importance of early treatment


A child with untreated amblyopia will always have defective vision. A child with a constant squint will have no binocular vision. Early amblyopia treatment and/or squint operation may be required to enable the squinting child to have good vision in both eyes with normal binocular function.





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