Squint (Strabismus) in children

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What is Squint?

A squint (strabismus) is a condition where the two eyes look in different directions and are misaligned (the two eyes do not point in the same direction). Whilst one eye looks forwards to focus on an object, the other eye turns either inwards, outwards, upwards, or downwards. Squint affects approximately 1 in 20 to 1 in 50 children under the age of 5 years.

Will squint affect my child’s vision?

Yes, squint can affect a child’s vision in different ways. It can lead to lazy eyes (Amblyopia), double vision, blurred vision, and loss of depth perception (3D Vision).

Can squint be treated/ corrected?

There are various ways to treat/ correct a squint. This may involve a combination of spectacles, prism lenses, Botulinum toxin injection to the eye muscle and surgery.  If your child has a lazy eye, your surgeon will usually recommend treatment to improve the sight in the affected eye before surgery. As each case is different, a detailed and tailored management plan will be provided during your child’s consultation.

What does the operation to correct squint involve?

Each eye is controlled by 6 different muscles which move the eye in a particular direction. A squint operation involves either loosening or tightening these muscles to improve the alignment of the eyes. Your surgeon will make a small cut in the surface membrane (conjunctiva) of the eye to access the muscle that needs tightening/ loosening. For example, in a child with an inward turning squint (esotropia), the surgeon will loosen the muscle which pulls the eye in and/or tighten the muscle which pulls the eye out.

What are the benefits of correcting a squint?

The main benefit of the surgery is to restore the normal alignment of the eyes. This not only results in improved cosmesis, but also will help the two eyes function as one unit. The main goals of surgery are to:

  • Straighten the eyes
  • Promote use of both eyes together (binocularity)
  • Reduce double vision.
  • Reduce an abnormal head posture

Are there any risks involved with the surgery?

Squint surgery is generally very safe, and complications are rare. But as with any surgical procedure, there are some risks associated with the procedure. The risks vary with each patient and Mr Shenoy will go through these in detail at your pre-operative clinic consultation. The commonly occurring complications are:

  • Mild bleeding of the eye after surgery
  • Redness of the operated eye/s
  • Persistent redness and scarring at the site of surgery
  • Noticeably over or under correction of the squint needing further surgery.
  • Infection
  • Change in focus of the eye – meaning there could be a need for glasses or alteration of the power of current glasses after the operation.
  • Double vision which may be present for the first few days and then settles down. If the problem continues, your child nay need further intervention by means of special glasses or Botulinum toxin or further surgery.

A general anaesthetic is required, which carries a small risk. Your anaesthetist will discuss these risks with you before the operation.

What is the after care after the surgery?

Your child should be able to go home the same day following the surgery. You may clean around your child’s eye if necessary. Always wash your hands before starting. Using cotton wool moistened with cooled, boiled water wiping from the inner corner of their eye to the outer and discard. Repeat if required. There could be some tears from the eye which are slightly blood stained. This is quite normal and usually clears up after a few days. You will be given some eye drops for your child, to use at home for 2 – 4 weeks. You will be advised how to use the medication before you leave hospital.

Restrictions after the surgery

Your child may bathe and shower as normal, but make sure they do not get soap or shampoo in the operated eye for at least two weeks. Your child should avoid swimming, playing contact sports and playing in a dusty environment for between 2 weeks following their squint surgery. Your child should not usually require more than 2-5 days off school.

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