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Squint
 
Squint, also known as "strabismus", is a condition in which the eyes are not aligned in the same direction. Squint is sometimes also called 'lazy eye' or 'cast', according to the direction of the turn of the eye. The squinting eye may turn in (converge) or turn out (diverge) or sometimes turn up or down. Squint may be present all or only part of the time, sometimes in one eye or alternating between two eyes.

A squint can occur for a number of reasons like:
Eye muscle imbalance
Faulty nerve signals to muscles
Refractive (focusing) abnormality
Childhood illnesses
Heredity
Injury?
Rarely, it can be due to other diseases or illness.
Treatment of squint is different for adults and children.
CHILDHOOD SQUINT:
Squint is relatively common in children, and 2-3% of the population are born with a squint. Treatment is advisable as soon as possible and is most effective in very young children. The cause is not always known, but if squint is suspected, then the baby should be seen for an accurate assessment at the earliest opportunity. Sometimes a "pseudo or false squint" may be present where the eyes appear to be misaligned but do not actually have a squint. It is called 'epicanthus' and is caused by folds of skin, a wide nose, flat nose bridge or due to wide gap between the eyes etc. Epicanthus does not exclude the possibility of a squint being present and you should always seek an expert opinion.

Newborn children may have a certain degree of misalignment of the eyes, which usually disappears by about 6 months of age. However, if it persists beyond 6 months then the child should immediately be examined by an eye surgeon immediately.

The child is thoroughly assessed to establish the type of squint. It is very important to note the vision and fixation pattern in both eyes. Treatment varies according to the type of squint and can be in the form of spectacles, occlusion, eye-drops (rarely) or surgery.

Some squints, especially those that arise from hypermetropia (long sightedness) respond well to treatment with the use of spectacles . The child will be seen from time to time to note the change in spectacle power and degree of squint till he grows up. Any residual squint not corrected by spectacle can then be corrected by surgery.

Amblyopia / Lazy eye : This is treated by patching / occluding the good eye. The weaker eye is encouraged to work harder with visual activities such as coloring and reading while the patch is on. It should be noted that amblyopia can only be treated before the age of about 9 years after which the visual system of the eye becomes fixed and fails to respond to occlusion therapy .

Surgery : Sometimes this is the only choice to straighten the eye. If done at an appropriate time the results can be very good and proper 3 D vision can develop. One or both the eyes may have to be operated on. One or more operations may be required to achieve perfect functional results (cosmetic correction is usually easier to obtain).
ADULT SQUINT:
When an adult suffers from squint, it is not only imperative to establish the type and amount of squint but also to establish and treat the cause of squint. There are two main types: non-paralytic or paralytic squint .

The non-paralytic variety either persists from childhood or is a local eye muscle imbalance. Any adult suffering from a sudden onset of paralytic squint must be investigated to establish the cause. Possible causes, which could be medical, are: - hypertension, diabetes mellitus or brain lesion. The majority of such squints self correct within 6 months and surgery is only required in cases where squint persists.
Is squinting only a cosmetic problem?
Squint is not just a cosmetic problem. It is always associated with certain degree of functional defect such as decreased vision, lack of coordination, between both eyes ( amblyopia or lazy eye) or double vision ( diplopia ). Loss of binocular vision (ability to use two eyes together) can lead to loss of fine depth perception ( stereopsis ) and peripheral visual field.

Squint is assessed by various orthoptics tests which:
Establish the amount and type of squint
Assess how well the child /adult sees
Detect the presence of refractive errors
Test for binocular vision
Examine the Retina including fixation pattern
Investigate for the cause of squint
Squint surgery is conducted under local anesthesia in adults and general anesthesia in children. It is not uncommon for more than one operation to be necessary. This does not mean that something has gone wrong but that fine-tuning is needed to obtain the best straight alignment. Sometimes the squint is so large that two-stage surgery is planned.

Squint surgery is a day care procedure not requring hospitalisation (unless general anesthesia is used). The eye pad is removed the next day and eye drops are applied for the next weeks. Since it is an external surgery there is no effect on vision. Most of the time absorbable external stitches are used and do not have to be removed. The person can return to work after 2/3 days of rest although a certain amount of redness and irritation may persist longer.