Squints in children
- Squint is a vast topic and only the most common forms of squint in young children are referred to briefly. A squint or strabismus may be primary (the most common kind) or secondary to an underlying cause.
- ANY squint, whether constant or intermittent, occurring in a child after the age of three months, should always be properly assessed by an eye specialist.
- The eye specialist’s first task is to exclude underlying (sometimes serious) causes of strabismus. These may include congenital conditions, rare neurological syndromes, brain tumors, birth injuries and localized eye diseases. Fortunately these causes of strabismus are by far the minority.
- Secondly, it is of paramount importance to ascertain whether the young child’s vision is normal and equal in both eyes. Poor vision in one eye may cause a squint. Equally important is the fact that an otherwise normal eye may loose visual ability and become lazy or amblyopic, because of a squint. This danger exists until the age of roughly 9 years.
- If it is diagnosed early, an amblyopic eye may be stimulated with reasonable success to improve and normalise visual ability. After the age of about 9 years visual ability is permanently fixed and can not be manipulated.
- All the above information can only be obtained by thorough and sometimes repeated ophthalmic examination, which may even require examination under anaesthetic.
- A dilated examination of the eye and cycloplegic refraction (having enlarged the pupils with eye drops) is an essential part of such an assessment. If a significant refractive error (spectacle error) is present, its causative role should be assessed by a trial period of wearing the appropriate spectacles. A purely refractive accommodative squint will be eliminated by the spectacles alone.
- In a second group of children the spectacles may reduce but not eliminate the squint. If the residual squint is significant it may be surgically corrected. After surgery the use of spectacles will still remain essential.
- In a third group of children a refractive error is not relevant and surgical repair alone should eliminate the squint.
- Although squints are often referred to as being left or right sided, a squint involves misalignment of BOTH eyes and surgical repair is seldom attempted before BOTH eyes have equal and normal visual ability. Likewise, strabismus surgery is often done on both eyes, whether at one or more than one session.
- Even after successful surgical or other correction of strabismus the danger of amblyopia remains until the age of approximately 9 years and regular follow up visits should be made regardless of a good cosmetic result.