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Squint
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This is a condition when there is a misalignment of the eye. This could be prevalent at birth or may occur later in life, even as adults. Some of these children may also develop poor vision in one eye because of the squint. Adults with recent onset of squint often have double vision. Some types of squint may also be secondary to diseases of the brain and nerves. Most types of squint are correctable by surgery. Some are treated with glasses and exercise. Hence any child with a squint or adult with a sudden onset of squint or double vision needs to have their eyes checked by an ophthalmologist as soon as possible.

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 Ambylopia or Lazy Eye. Squint in children should never be ignored or it may lead to permanent damage to the visual apparatus.

Since an adult cannot ignore the image from either eye, and therefore has double vision. This can be very annoying and may interfere with work.

Symptoms

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.

Primary Open-Angle Glaucoma is the most common type of glaucoma affecting people according to the American Academy of Ophthalmology (AAO). It is a silent vision stealer. It doesn’t give symptoms in the early stage but gradually causes loss of peripheral vision first.

The affected people may not notice the loss of vision and by the time they visit an ophthalmologist, they may have lost a lot of vision – which can never be regained because of permanent damage to the optic nerve-before it gets diagnosed. In later stage, Glaucoma can lead to tunnel vision, where you can just see straight and it can eventually lead to blindness.
In Normal Tension Glaucoma even at lower intraocular pressure there may be damage to the optic nerve due to factors such as decreased blood flow into the eye.

In Angle Closure or (acute) Glaucoma there is a sudden rise in eye pressure and it can cause severe eye pain, blurred vision, sudden visual disturbances, halos around lights, reddening of the eye, nausea and vomiting. This form usually requires immediate treatment.

Treatment

The aims of treatment of Squint in order of importance are

Preserve or Restore
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 or LAZY EYE 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.

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.