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Squint |
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Definition
A Squint is defined as a condition, where the two eyes are not straight or aligned properly. The visual axis of the two eyes does not meet at the point or object of regard. The eyes may be deviated inwards or outwards and rarely upwards or downwards. It may be constant or intermittent. It is a common condition among children.
Incidence
5 to 8 % squint or squint related conditions. The common age for a child to develop a squint is between 10 months & 2 years.
Causes
- Hereditary
- Birth injuries – nerve damage
- Long sightedness (Hypermetropia)
- Childhood illness
- Prematurity
- Cerebral palsy
- Brain tumors
- Faulty muscle balance
- Congenital squint
- Conditions affecting the vision of one eye. Eg: Cataract, injuries of the eyes
Types
- Concommitant
- Latent
- Esophoria
- Exophoria
- Hyperphoria
- Hypophoria
- Inconcommitant
- Manifest Microtropia
- Esotropia
- Exotropia
- Hypertropia
- Hypotropia
- Infantile
- Non Accommodative
- Accommodative
- Partially Accommodative
- Convergence Insufficiency
- Divergence Excess
- Basic Type
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Binocular Single Vision (BSV)
When both eyes have good vision and they are aligned properly, they focus in the same object. Each eyes sends image of the same object, viewed from a slightly different angles. These two images reach the brain, where they are focused to form a single three dimensional picture with depth perception. This is known as binocular single vision.
Amblyopia
It is a developmental defect of spatial visual processing that occurs in the central visual pathways of the eyes. It is defined as a condition with unilateral ( or ) bilateral subnormal vision ( at least 2 times less than normal ) without any local ophthalmoscopic abnormality, which is reversible if treated appropriately at the proper time.
Symptoms Of Squint
- Misalignment of eyes
- Double vision
- Poor vision in squint eye
- Altered head posture
Problems With Squint
- Failure to establish binocular single vision
- Amblyopia
- Double vision
- Suppression
- Loss of stereopsis
Early Detection And Treatment
According to both the American Optometric Association and American Ophthalmological Association, all children should have their first examination around 9 months of age. However, if an extreme or constant eye turn is noticed, the baby should be examined before 9 months. If a constant eye turn or significant refractive error is found, the eyes need to be fully evaluated and corrected as early as possible.
Pseudo Squint
This is the condition where the eye looks deviated because of structural facial abnormalities like, broad nose, epicanthic folds etc., It normally gets corrected with age and needs no treatment
Aims Of Treatment In Order Of Importance Are
- Preserve (or) restore vision
- Straighten the eyes
- Restore binocular single vision
Check the refractive error
If there is significant refractive error- Correct the refractive error. Some type of squint are corrected by glasses only.
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Check for Amblyopia
Treat the Amblyopia before surgery
Amblyopia Treatment
When the treatment procedure involves patching only, the child's clear eye is covered for 2 to 8 hours a day over a long period of time, from 3 months to a year. By forcing the blurry eye to work, its vision improves
1.Patching
2.Penalisation-Atropin Ointment
3.Vision Therapy
4.Orthopotic Exercises
The younger the age at which amblyopia is treated the better is the chance of recovery of vision.
Surgical Management - Indication for surgery
- Elimination of double vision
- Improvement of BSV
- Expansion of visual field
- Elimination of abnormal head posture
- Improvement of psychosocial function
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Methods
Surgery is done to straighten the eye. In this the weaker muscle is made stronger by cutting a piece and joining two ends (resection) and stronger muscle is made weak by cutting it from its attachment and taking the attachment back (recession) . Surgery may have to be done in one eye or both eyes depending on amount and type of squint.
 
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