About Squint:

Squint is a condition where the eyes point in different directions. It is most common in young children. While one eye looks straight ahead, the other eye may turn up, down, in, or out. This may occur constantly or from time to time. If untreated, squint can cause Lazy Eye and your child can start to loose vision in that eye. Luckily, vision loss can be prevented if treatment is started from a young age.

Causes:

  • Family history of squint
  • Weak eye muscles
  • Blurry vision from cataract, glaucoma, refractive errors, etc.
  • Eye injury

Key Points to Remember:

  • Squint is NOT a sign of good luck!
  • Early treatment is the only way to prevent permanent vision loss
  • Most treatment will require frequent follow-up for the best results
  • If the squint is detected later in life, it may not be possible to improve vision. However, surgery can be used to straighten the eyes so they look normal.

Some symptoms of squint include:

  • Eyes point in different directions
  • Poor vision in one or both eyes
  • Closing one eye in bright sunlight
  • Tilting the head in a specific direction to use the eyes together
  • Double vision

See an eye doctor if your child shows symptoms of squint. Early treatment is the best way to stop vision loss.

Squint must be treated as early as possible. It is best if treatment is started before the age of 2. Treatment may include spectacles, patch therapy, eye exercises, and surgery.

Spectacles:

When the squint is caused by uncorrected refractive errors, wearing spectacles will correct the same.

Eye Exercises:

When the squint is small and occurs transiently, particular specific exercises can help to strengthen the eye muscles there by the squint.

Squint Surgery

Surgery is recommended to straighten the eyes, so that they point in the same direction.

What to Expect Before Surgery:

  • Your child’s doctor will run some tests to make sure the surgery is safe for your child’s eyes. Children with a fever, common cold, or cough may need to recover before the surgery.
  • Your child may have to stop eating and drinking a few hours before the surgery

During Surgery:

Squint surgery will take around one hour. Your child will be under general anesthetic, so they will be asleep. This is to prevent them from moving or feeling any pain. The surgery may be done on one or both eyes. It is done on the white part of the eye.

The surgery is three main steps:

  1. The surgeon detaches the eye muscles from their original spot.
  2. The muscles are reattached in a new spot, so the eyes point straight and in the same direction.
  3. Small stitches are used to fix the muscles in place. The stitches do not need to be removed and will get absorbed into the body. You will not be able to see them after the surgery.

After Surgery:

In most cases, patients only need to spend one night in the hospital after surgery. After going home, they may need additional treatment. For example, your child may need more patch therapy or visual exercises. Your child may also need glasses.

Risks & Complications:

Patch therapy, eye exercises, and glasses do not have any risks. The risk of surgical complications is extremely low. They include:

  • Permanent double vision
  • Infection
  • Some vision loss
  • Need for a second surgery

Risks of NOT getting treated:

Squint is NOT a sign of good luck. Early treatment is needed to prevent permanent vision loss in the affected eye. This may or may not include surgery. If the squint is detected later in life, it may not be possible to improve vision. However, surgery can be used to straighten the eyes so they look normal.

Squint - Before & After Surgery

Patch Therapy:

Patch therapy is a treatment where one eye is covered to encourage the use of the weaker eye. It is most effective in helping young children strengthen an under-developed eye. The earlier the treatment begins, the stronger the weaker eye becomes. This is commonly used to treat lazy eye and squint.

In both cases, one eye is weaker than the other. The patch covers the good eye, forcing the child to use the weaker eye. In this way, the weaker eye becomes stronger.

What to Expect: About Patch Therapy

  • Wearing the patch can be very uncomfortable. If your child wears spectacles, put the patch on before the glasses. The patch should be stuck on the face, not the glasses.
  • The edge of the patch should be carefully sealed so the good eye is completely blocked.
  • As an alternative, homemade patches / special glasses can be used instead of a patch in older children
  • Patching schedules should be strictly followed.
  • Young children may initially resist wearing the patch. Hence, start with short periods of time and slowly increase the timings for better results.
  • During patching: Older children should read and younger children should play fun games/eye exercises.
  • Your child will start accepting the patch when vision improves in the weaker eye.
  • Regular follow-up visits are a must.

Side Effects:

Patch therapy is very safe and has no side effects.

Patch Therapy

What is patch therapy?

Patch is used to cover your child’s good eye, so the eye with lower vision is stimulated. This strengthens the weak eye.

How should the eye be patched?

Readymade patches are available. Sticker patches can be stuck directly over the eye. Patches made of cloth with sticking tape at the edges are also available.  You can select the patches to suit your eye.

When can we start patch therapy?

Immediately after the diagnosis and doctor’s advice.

Can patch therapy be used in a child above the age of 8?

Yes, if this has not been done earlier at when the child is found to have difference in spectacle power.

How many hours of patch therapy should be done?

This depends on the severity of the squint. Your doctor will make this decision. If vision is only slightly reduced, the patch may be worn for 4 hours a day. If vision loss is worse, it should be worn for 6 hours per day.

Can my child sleep during patch therapy?

No. The purpose of patch therapy is to get the child to use their weak eye. This cannot happen during sleep. So, your child should read books, draw, or use colored toys while wearing the patch.

If my child wears glasses, should they wear them during patch therapy?

Yes, but the patch should be stuck to the face, not the glasses. Glasses should be worn on top of the patch.

What can the child do while wearing the patch?

The patch should always be worn with adult supervision. Younger children should be encouraged to do drawing or colouring exercises. Older children should read.

My child is not co-operating with patch therapy. What can be done?

At first, the patch can be used for shorter times. Gradually, the time will need to be increased. Vision will only be improved if your child follows their patching schedule. As your child’s vision improves, they are more likely to accept the patch. But, they may need some encouragement and fun activities from their parents along the way.

For how long does the treatment have to be continued?

This depends on the improvement of vision. It may last a few months to a few years. The critical period for treatment is the first 8 years of life. Patch therapy will be continued as long as the vision is improving.

When and why does patch therapy end?

Once the vision reaches its maximum possible level, patch therapy is slowed gradually. Eventually, it is stopped completely. If the patch does not improve vision after two or three 6-month checkups, then the patch is also stopped.

How frequently should the child visit the eye doctor?

This will be decided by the doctor. If the patch is used to treat alternating squint, then the follow-up is every 2 months. Otherwise, it is every 3-4 months.

Why are we coming in every 3 months for a checkup?

At every follow-up, vision is checked to see if there’s any improvement. The checkups will gradually become less frequent as the child’s vision gets better.

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