Paediatric & Squint

Strabismus (Squint) a misalignment of the eyes, is one of the most common eye problems in children, affecting approximately 4 percent of children under the age of 6 years. The eyes (one or both) may turn inward, outward, turn up, or turn down. At times, more than one of these conditions are present. Strabismus is also called “wandering eye” or “crossed-eyes.”

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.
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 IS BINOCULAR VISION
Under normal circumstances, when both the eyes have good vision and they are aligned properly, they focus on the same object. Each of the eyes sends picture of the same object, viewed from a slightly different angle. These two images reach the brain, where they are fused to form a single three-dimensional picture with depth perception. This is known as binocular single vision.
OVERVIEW

Strabismus (Squint) a misalignment of the eyes, is one of the most common eye problems in children, affecting approximately 4 percent of children under the age of 6 years. The eyes (one or both) may turn inward, outward, turn up, or turn down. At times, more than one of these conditions are present.

Strabismus is also called “wandering eye” or “crossed-eyes.”

Experts do not completely understand the cause of strabismus, but it results from failure of the eye muscles to work together. The brain controls the eye muscles, which are attached to the outside of each eye. About 50 percent of children with strabismus are born with it. There appears to be a higher incidence of strabismus in children with disorders that affect the brain, such as cerebral palsy or hydrocephalus. Strabismus may also occur later in life as a result of an illness, cataract, or eye injury.

All forms of strabismus have been found to cluster in families. Siblings and children of an individual with strabismus may have an increased chance to also develop it. However, a single inherited cause has not been identified.
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.
EVALUATION
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.

It is normal for a newborn’s eyes to move independently and at times, even cross. However, by three to four months old, an infant should be able to focus on objects and the eyes should be straight, with no turning. If you notice that your child’s eyes are moving inward or outward, if he/she is not focusing on objects, and/or the eyes seem to be crossed, you should seek medical attention. Thirty percent to 50 percent of children with strabismus develop secondary vision loss, amblyopia, also known as lazy eye). The onset of strabismus is most common in children younger than 6 years of age.

The symptoms of strabismus may resemble other medical conditions. Always consult your child’s physician for a diagnosis.

Early detection and treatment can prevent permanent visual impairment. Strabismus is diagnosed during an eye examination. Eye examinations are recommended for all children by the age of 3. However, if your child is having symptoms of strabismus or other eye disorders at any age, a complete eye examination should be performed.

Treatments

Pediatric Ophthalmology - Squint - Strabismus
TREATMENT The aims of treatment of squint in order of importance are: Preserve or restore vision Straighten the eyes Restore binocular vision Your child’s physician will determine specific treatment for strabismus based on: • Your child’s age, overall health, and medical history • The extent of the disease • The cause of the disease • Your child’s tolerance for specific medications, procedures, or therapies • Expectations for the course of the disease • Your opinion or preference Your child may be referred to an ophthalmologist for treatment of this problem. Treatment may include one or more of the following: • Eye drops • Eye exercises • Eye patch over the strong eye (if amblyopia is present) to improve the weak eye • Glasses • Surgery to straighten the eyes Strabismus cannot be outgrown, but early treatment can prevent visual impairment. Are glasses necessary: Yes, Surgery cannot replace the need for glasses. If the child has significant refractive error, glasses are a must. In some cases wearing glasses may correct squint. In other cases, wearing glasses help the eyes to see clearly. This clear vision is very important for the treatment of amblyopia, and also for maintaining the coordination of eyes, once they have been aligned by surgery. View

Pediatric Ophthalmology - Squint - Strabismus

TREATMENT

The aims of treatment of squint in order of importance are:

Preserve or restore vision
Straighten the eyes
Restore binocular vision

Your child’s physician will determine specific treatment for strabismus based on:

• Your child’s age, overall health, and medical history
• The extent of the disease
• The cause of the disease
• Your child’s tolerance for specific medications, procedures, or therapies
• Expectations for the course of the disease
• Your opinion or preference

Your child may be referred to an ophthalmologist for treatment of this problem. Treatment may include one or more of the following:

• Eye drops
• Eye exercises
• Eye patch over the strong eye (if amblyopia is present) to improve the weak eye
• Glasses
• Surgery to straighten the eyes

Strabismus cannot be outgrown, but early treatment can prevent visual impairment.

Are glasses necessary:

Yes, Surgery cannot replace the need for glasses. If the child has significant refractive error, glasses are a must. In some cases wearing glasses may correct squint. In other cases, wearing glasses help the eyes to see clearly. This clear vision is very important for the treatment of amblyopia, and also for maintaining the coordination of eyes, once they have been aligned by surgery.

View