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​Mr Greg Richardson,
BMedSci (Hons), MMedSci
Consultant Orthoptist

Mr. Richardson has over 10 years of experience working in all aspects of paediatric and adult orthoptics, with a particular interest in neuro-orthoptics. He is a specialist in eye movement disorders, amblyopia and vision development. In this week’s Clinica newsletter on squint (strabismus), he talks about how strabismus surgery and how squint can develop differently in children than in adults.

What is an eye squint/strabismus?

A squint is medically called strabismus. It is a condition whereby the eyes point in different directions; it is usually the case that one of the eyes may turn in, out, up or down, while the other looks straight ahead. This normally occurs when some of the muscles around the eye aren’t as strong as they should be and struggle to work together. Although a squint can occur at any age, it is much more common in young children and it can influence their visual development.

Can squint be cured?

The good news is that a squint can be corrected at any age. However, it is important to ensure that the affected eye continues to process visual information. Children may stop the process of information through the squinting eye while relying on the other eye. This could lead to a reduction of vision in the impacted eye, also known as amblyopia, or a lazy eye. If your orthoptist or paediatric ophthalmologist thinks amblyopia treatment is required, this may involve patching the better seeing eye, or using drops that blur the vision in the better seeing eye, so that the brain will be forced to use the weaker eye to see better.

Some types of squint can be corrected merely by wearing glasses or by undertaking eye exercises, however others may need an operation. Some types of squint may benefit from both glasses and surgery. Your orthoptist and paediatric ophthalmologist will be able to advise which form of treatment is right for your child’s squint.

Are children normally born with a squint?

Although some babies are born with a squint (strabismus), others acquire squints due to the eye trying to overcome a vision problem, such as long-sightedness. However, the development of a squint in many cases is unknown. On rare occasions, a squint could result from a condition in the eye itself.

Can watching TV cause a squint?

Like any other muscle in the body, muscles around the eye can become fatigued by too much screen time. This can increase symptoms related to an underlying hidden squint, so it is therefore important to take regular breaks.

What are the symptoms of squint?

Eyes that look in different directions
Eyes that don’t move well together
Squinting or closing an eye during brightly lit places or in direct sunlight
Squint acquired in adults, as oppose to children, or once binocular vision has fully developed, can result in double vision.

What are the treatments for squint?

The first step in management of squint is always to have a glasses test and assessment by the Orthoptist and Paediatric Ophthalmologist. If a glasses prescription is required, this can have an impact on the size of the squint. In some types of squint wearing glasses or contact lenses will eliminate the misalignment of the eyes completely, allowing both eyes to work together as a pair again. When the two eyes work together this is called medically binocular vision.

Once your child has adapted to their new glasses prescription, if there is a residual squint, they may benefit from either an operation to correct the position of the eyes, or sometimes an injection of Botox into the eye muscles.

If your orthoptist or ophthalmologist thinks that your child’s squint requires surgical correction, this is done under general anaesthesia, and takes approximately 1 hour to complete. The surgery involves one or more muscles being delicately moved in relation to the eye and tiny stitches placed to reattach the muscles. Following the operation, a pad may be put over the eye, which can be removed by the parent at home a few hours later, then drops put in.

Is squint surgery painful?

Strabismus surgery is not usually painful, although the eye may feel uncomfortable post-operation for a few hours to several days. The typical experience is moderate discomfort that normally responds to light analgesia.

What are the post-surgery results?

After strabismus surgery, there are antibiotic steroid drops to use for the initial 4 weeks. There is a first follow-up visit with the Orthoptist and the Paediatric Ophthalmologist during that time to check the healing and to look at the initial post-operative measurements to assess for improvement.

Surgery carries a success rate of around 80%. Some patients may require further surgery, depending on what they have already had done, and occasionally squint surgery may be staged for more complex squints, and your orthoptist and ophthalmologist will advise if this is going to be the case.

If your child already wears glasses, these may have to continue to be worn and the visual development regularly monitored by the Orthoptist until they are about 10 years old.

At Clinica London Ms Naz Raoof is the Paediatric Ophthalmologist who does children’s squints, working closely with the Orthoptists on a Wednesday each week.

COVID-19 at Clinica London

To ensure your safety and the safety of the staff, all staff are tested for COVID-19 twice weekly and our staff have been vaccinated.

If you feel it is the best option for you, we are also offering video consultations to patients throughout the pandemic.

Mr Greg Richardson

Consultant Orthoptist
Specialist in Paediatric, Adult and Neuro-Orthoptics.

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