All about squint (eye deviations, strabismus)
Eye squint or deviation is a disorder related to inability to coordinate eye movement, leading to both eyes moving in different directions, and not being able to gaze at one point, and this may be caused by a disorder of the muscles or nerves responsible for eye movement, injury or trauma to the eye or its extraocular muscles, or a disorder of the brain’s ability to coordinate eye movement.
Eye squinting ( strabismus )can be classified according to the direction of the eye turn or deviation:
- Esotropia: the affected eye gazes inward towrds the nose
- Exotropia: the affected eye gazes outward .
- Hypertropia: the affected eye gazed upwards
- Hypotropia: the affected eye gazes downwards
Causes of strabismus
- Strabismus is usually has a genetic predisposition, which can exist from birth due to a muscle disorder.
- In less severe cases, the strabismus develops later in life.
- Sometimes strabismus can develop in school age when the child starts to read or gets more involved in near work
- Childhood diseases or accidents (such as difficult childbirth) can cause muscle paralysis and nerve injury that may result in squint or strabismus.
Mechanics of squint surgery:
- The main idea behind the surgery depends on the repositioning of the muscles, i.e. tightening the weaker muscles and relaxing the stronger ones.
- Usually horizontal and vertical deviations coexist, and must be corrected simultaneously (horizontal and vertical muscles)
- Mild dizziness may be felt the next day.
- You can eat normally once you have fully recovered from the anesthetic .
Instructions after squint surgery:
- The patient should stay a few hours after surgery to ensure full recovery from the anesthetic , and it is not necessary to bandage the operated eye .
- Analgesics are often not necessary because the patient only feels a slight irritation due to mild eye inflammation.
- Antibiotic and anti-inflammatory drops will be prescribed for the following 1-4 weeks postoperative.
- Sunglasses are recommended especially in the first few days after surgery.
- Swimming and dusty areas should be avoided for 2-4 weeks to avoid additional inflammation or the onset of complications.
- After surgery, the patient should train his or her eyes and to exercise certain gaze positions. This is done to coordinate the muscles and to avoid adhesions.
- Reading and watching TV shortly after surgery is generally permitted, although the patient may not enjoy it due to the initial pain felt after the surgery
- Parents that suspect that their child has an abnormal eye deviation, or a strange pupillary color or reflex (other than black), or abnormally shaped or sized eyes must seek immediate advice from a trusted ophthalmologist for complete eye examination and examination of the retina to rule out serious eye conditions such as tumors and severe defective vision, and to rule out strabismus.
To summarize, the treatment options available for strabismus are either
1) Prescription glasses
2) prescription glasses and strabismus surgery to correct the residual deviation if the glasses alone are not enough.
An important note:
There have been numerous attempts to advertise so called laser strabismus surgery or laser refractive surgery for the elimination of strabismus in children. These are all conscience lacking commercially driven campaigns to lure the parents of squint patients in rural areas and Upper Egypt where it is culturally unacceptable for a child to wear glasses. we strongly warn against any of these procedures or any intervention to correct vision by lasik before the age of 18, except in a single case where there is a large difference between the refractive power between the eyes, resulting in a marked difference in visual acuity anisometropia (more than 4 diopters) which results in double vision and the development of lazy eye.