Treatment for a squint where both eyes do not focus in the same direction is most successful when performed before the age of eight. Children with squints need to be treated as soon as possible after diagnosis.
 

A squint, known medically as strabismus, describes the situation in which one eye points straight ahead while the other turns inwards or outwards, or looks up or down. The result of this is that the brain favours the straight eye over the other eye, and the eye that is misaligned often becomes ‘lazy’.

A lazy eye develops because the nerve pathways in the optic nerve do not form properly. The eye needs to be used for this to happen, and in a child with a squint, one eye is ignored, so those important nerve pathways never develop.
Non-surgical methods of treating a squint

The first treatment to correct a squint is to prescribe glasses, if appropriate, as this can often straighten the eye. The next step is to make the eye that is misaligned work harder to improve its capacity for vision. This can involve:

  • Patching to cover up the ‘good eye’ to make the ‘lazy eye’ work harder. Patching is done directly onto the skin using non-irritant material, and any glasses needed are worn on top. Getting a child to wear a patch can be difficult, but it needs to be done for several hours a day as prescribed, particularly when doing reading or close work.
  • Atropine drops can be put into the ‘good eye’ to blur the vision. The child is then forced to use the ‘lazy eye’ and the nerve pathways can develop.
  • Botulinum toxin (Botox®) is a new and relatively controversial treatment that is only suitable for some squints. The toxin is used to paralyse muscles on one side of the eyeball to prevent the eye turning inwards. It is less invasive than surgery, but the effects may not be permanent.

Surgery for a squint
Patching or using drops can help improve the function of the lazy eye but it rarely straightens of its own accord. Squint surgery repositions the muscles around the eyeball and is done to make the eye point in the same direction as its partner.
This is a minor operation but it is usually done under a general anaesthetic. Recovery time is fast, and usually requires only an overnight stay in hospital.
 

Adults who retain a squint from their childhood, or who develop a squint later in life, may also be treated by surgery to straighten the eye.
 

Squint surgery – what is involved?

The first step is a pre-operative assessment to measure the degree of the squint and to examine how well the eye muscles work. If the eye muscles on one side are paralysed or do not function well, this can affect the results of the squint surgery. The normal checks of blood pressure and suitability for anaesthetic are also done.
 

On the day of the operation, your child will be admitted to The Clinic as they will need to have a general anaesthetic. Adult squint surgery can be performed with a local anaesthetic, which makes it possible to check how well the eyes are aligned before the surgery ends. It is also possible to complete the operation under a general anaesthetic but to leave an adjustable stitch in place. This is sometimes done in older children and allows fine adjustment under local anaesthetic after recovery from the general anaesthetic.
 

The procedure for squint surgery in detail

Squint surgery usually takes only 20 minutes and consists of the following stages:

  • The skin around the eye is opened up slightly so that the surgeon can gain access to the muscles that hold the front of the eyeball in place.
  • The muscles are then either tightened by removing a small section from the eyeball surface and then attaching it in a new position further forward, or loosened by reattaching the muscle further back.
  • The skin around the eye is then stitched and the operation is complete.

 

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