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Squints

Squints in Children:- A squint occurs when one eye is straight and the other eye turns away from 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.

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. 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. An eye that has poor vision from lack of use is said to be lazy or amblyopic.

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.

Glasses and Squints

Some squints can be caused by uncorrected long- sightedness (hyperopia) or short- sightedness (myopia).Glasses can sometimes reduce or completely eliminate the squints 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 surgery is then needed for the remaining squint.

Pseudo Squints

Many Asian babies, particularly among the Chinese, 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.

Treatment

Treatment of a child with a squint consists of two parts:

1 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.

2 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.

When surgery should be done:
In a young child with a constant squint, surgery should be done once vision is equal in both eyes to enable binocular vision to develop.

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.

Myths

Myth: “All babies squint”
Fact: 
They do not. Although the eyes are initially uncoordinated, control of eye movements is achieved at approximately three months of age.

Myth: “Children under the age of two years cannot be examined”
Fact: No child is too young to be examined for a squint. If squinting is present and detected early, appropriate treatment can be taken.

Myth: “No harm will occur if a squint is left alone as a child will outgrow it”
Fact:
 The child can suffer gross loss of vision (amblyopia) in the squinting eye, which may become permanent, if neglected.

Myth: “You need not correct a squint that is not severe”
Fact:
 A small squint is likely to result in amblyopia and defective binocular vision as a squint. The child should be referred to the doctor as early as possible for treatment.

Myth: “Squints can be straightened at any age, therefore, delay does not matter”
Fact
: Although surgery can be performed at any age, it may only improve the cosmetic appearance. Early surgery (after appropriate amblyopia treatment) can restore full- coordination of both eyes and lead to binocular vision.

Myth: “Squint operation means the child can leave his glasses off afterwards”
Fact: 
Surgery will only alter the position of the eyes. It does not correct poor vision from refractive errors.

Importance of Timely 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.

Know More ‘The Final step’

Information given above provides only a preliminary introduction to Squints. Finding out more about it is the next step towards visual independence. This is accomplished by calling Dr. Hardia Hospital for a consultation with doctor.