What exactly is a squint? Will my child need surgery?

What exactly is a squint? Will my child need surgery? When is the right time to intervene? Will treatment be successful? Will the eyesight be ok? Will my other child be affected? These are just some of the questions parents ask me when I tell them that their child has a squint. Understandably there is often huge anxiety when anything wrong with the eyes is diagnosed but also sometimes relief to know that it has been picked up and will be dealt with appropriately. Each child must be investigated and treated as soon and as individually as possible as there are many different types of squints and often subtypes as well! Let me explain in further detail. A squint describes a condition in which the two eyes are not pointing in the same direction. One eye may turn in (“convergent” squint), out (“divergent” squint) or less commonly up or down. Squints affect approximately 4% of the child population. The medical term for a squint is “strabismus”. When do squints develop? Squints can occur at any age. Babies can develop a squint soon after birth or a squint may occur late into adulthood (e.g. from a nerve palsy). Babies’ eyes that wander around and appear to be squinting can be normal under six months of age, but if during this period a squint becomes constant or if the squinting/wandering tendency persists after six months of age the infant needs to be fully assessed. What causes a squint? A squint becomes manifests when the six eye muscles are not in perfect balance. This prevents both eyes from being used together as a unified pair.

The exact cause in the majority of cases is poorly understood but the root of the problem seems to lie in the part of the brain associated with eye movement and coordination. In other cases specific causes can be identified and corrected. Certain associations in both types may be:
– A family history of squint
– Long- or short-sightedness – difficulties focussing can result in convergent or divergent squints
– Illnesses may precipitate a squint e.g. chickenpox or the common cold

How will my child be investigated and treated?

Your child will be examined by your ophthalmologist to assess the visual acuities, to confirm the squint and its features, and to look for known associations that may have caused or triggered the squint. It is essential that your child has a dilated eye examination to rule out long- or short-sightedness and intra-ocular problems (like cataract and retinal problems). Armed with all this information the ophthalmologist will be able to tell you the most appropriate treatment options.

Each type of squint has unique treatment options and this will be discussed with you. For every patient, especially those under eight years of age, the vision needs to be assessed prior to treatment. For example one eye may have suffered visually from the squint and may have become “lazy” (“amblyopic”). This would need to be addressed by patching, etc. For early onset convergent squints (those presenting before one year of age) the most appropriate treatment is surgery to realign the eyes. This is best done at around 2 years of age. Another common type of squint is due to the focusing effort your child may be using to make near and distant objects clear. This is from being long-sighted and is often well managed just with glasses. In the older child/adolescent divergent squints are more common and may be associated with short-sightedness. This type of squint is often variable and intermittent. The child may tend to close one eye in bright sunlight. Treatment for this type of squint is glasses if necessary but may also involve surgery if the squint angle is large. Generally with most squints the prognosis with treatment is very good. Those requiring surgery are re-aligned in the vast majority of cases although some may require further surgery. As long as the eyesight is monitored and treatment initiated then there should be little long-lasting visual impairment. Will my other child be affected? As mentioned above, squints tend to run in families but they do not conform to strict inheritance patterns and as such it is very difficult to predict whether siblings will be affected. They are however at increased risk compared to the general population. So, in summary squints are common but correctable and should be dealt with promptly if suspected. This article is not meant to replace the advice of your GP or eye specialist so please do seek medical attention if you have any concerns.

Squint facts:

– Squints are common (4% of children)
– Squints tend to run in families
– A child is never too young to be examined or for treatment to be commenced
– Squints may be corrected with glasses, prisms or surgery
– Squints may permanently affect the vision, so patching may be required as well
– With treatment the majority of squints can be cured

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