What is
squint (strabismus)?
Squint is a misalignment of the two eyes so that both the eyes are
not looking in the same direction. This misalignment may be
constant, being present throughout the day, or it may appear
sometimes and the rest of the time the eyes may be straight.
It is a common condition among children. It may also occur in
adults.
What causes squint?
The exact cause of squint is not really known. The movement of
each eye is controlled by six muscles. Each of these muscle acts
along with its counterpart in the other eye to keep both the eyes
aligned properly. A loss of coordination between the muscles of
the two eyes leads to misalignment. This misalignment may be the
same in all directions of gaze, or in some conditions the
misalignment may be more in one direction of gaze, e.g., in squint
due to nerve palsy.
Sometimes a refractive error hypermetropia (long sight) may lead
to inward deviation of the eye. Poor vision in an eye because of
some other eye disease like cataract, etc. may also cause the eye
to deviate. Therefore it is important in all the cases of squint,
especially in children, to have a thorough eye checkup to rule out
any other cause of loss of vision.
What are the problems with squint?
When the eyes are not aligned properly, each of the eyes is
focusing on a different object and sends signal to the brain.
These two different images reaching the brain lead to confusion
and may have either of the two effects:
A child would ignore the image coming from the deviated eye, and
thus sees only one image. But in the process, he loses the depth
perception. This suppression of the image from the deviating eye
results in poor development of vision in this eye, which is known
as amblyopia.
An adult can not ignore the image from either eye, and therefore
has double vision. This can be very annoying and may interfere
with work.
What are the symptoms of squint?
In a child, the parents may notice the deviation of eyes. It is
important to remember that the eyes of a newborn are rarely
aligned at birth. Most establish alignment at 3-4 weeks of age.
Therefore squint in any child who is more than one month old must
be taken seriously and should be evaluated by an ophthalmologist.
Adults may notice double vision, or misalignment of the eyes.
How is squint diagnosed?
The squint is diagnosed by the ophthalmologist. He or she would do
a few special tests to confirm the squint, to try and find out the
cause and to quantify the amount of deviation. In some cases there
may be a false appearance of squint due to broad nasal bridge in a
child. An ophthalmologist will be able to differentiate between a
true squint and false squint.
What is the treatment for squint?
The
aims of treatment of squint in order of importance are:
Preserve or restore vision
Straighten the eyes
Restore binocular vision
First of all, the eyes are checked to see if they have
any refractive error that may be responsible for squint. If there
is any significant refractive error present, it is treated first.
In some cases (accommodative squint) a correction of refractive
error is all that may be required to treat squint.
Next the eyes are checked for presence of amblyopia. It is
important to treat
the
amblyopia before the surgery for squint. The parents are explained
about the importance of this treatment, as their cooperation is
very crucial for the success of this treatment.
The squint is treated by surgery of either one or both the eyes.
The surgery involves weakening or strengthening of the relevant
muscles to restore the balance and to get a good coordination. In
some cases with double vision, prisms may be added in the glasses
to ease the symptoms.
When should the squint be treated?
In a child, the treatment of squint and any associated amblyopia
should be started as soon as possible. Generally speaking, the
younger the age at which amblyopia is treated; the better is the
chance of recovery of vision. Remember that the child would never
grow out of squint. A delay in treatment may decrease the chances
of getting a good alignment and the vision.
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