For children with strabismus, parents will often notice that their child’s eyes may be poorly coordinated or not aligned. In certain types of squints, the child may close one eye or tilt his/her head to compensate for the eye misalignment. Some individuals who develop strabismus in later childhood or adulthood might also experience double vision.
Many Asian children have an appearance of an in-turned eye. This is because they have a flatter nose bridge and a prominent skin fold that covers the inner aspect of their eyes. In such instances, the eyes are actually straight and merely appear closer together. This is a pseudo-squint (fake squint). No intervention is required for these cases, this in-turned eye appearance usually becomes less obvious due to changes of the face/eyelid as the child grows.
Having said that, all children who appear to have misaligned eyes should be reviewed by a doctor. Your child’s pediatrician or doctor will often be able to tell you whether your child has a true or pseudo squint and will refer him or her to an ophthalmologist for further assessment and treatment, if necessary.
Unfortunately, squints cannot be prevented. However, early detection and intervention may help to prevent it from worsening or prevent complications such as the development of amblyopia (or lazy eye).
Strabismus may run in families, but many people with strabismus do not have relatives with this condition.
Strabismus might be caused by abnormally high spectacle power or result from vision obscuration in one eye (e.g. childhood cataracts, droopy eyelids).
Occasionally, it may be due to an abnormality of the nerves supporting the eye muscles or an abnormality in the eye muscles and tissue within the eye socket.
Children who were born premature or individuals with certain conditions might also be at higher risks of developing strabismus.
Strabismus can be diagnosed during an eye examination. It is advised that you bring your child for a complete eye exam by an ophthalmologist if you suspect he or she has a squint, or if there is a family history of squint or amblyopia.
Strabismus surgery is a procedure performed on the muscles controlling eye movements. The specific type of eye muscle surgery will depend on the type of strabismus.
The surgery may be done under general anaesthesia (i.e. with the patient fully asleep); or under topical anaesthesia (i.e. with eye numbing eye drops) in co-operative patients.
An incision is made on the conjunctiva (i.e. the transparent layer of membrane covering the white part of the eye), then the eye muscles are located under this membrane and repositioned (i.e. either moved or shortened).
Absorbable sutures are used in most cases, these will dissolve and do not require removal. Non-absorbable sutures may also be used in special circumstances. The conjunctiva is then repositioned over the surgical site with absorbable sutures.
Any history of allergy or reaction to any medications, drugs, or food.
Any history of bleeding/clotting disorders
Any history of taking any drugs or herbs that thin the blood (e.g. warfarin, aspirin, ticlopidine, or clopidogrel), which may increase the risk of bleeding.
Inform the doctor if your child is unwell a few days before surgery
Adhere to the fasting guidelines provided
The eyes may or may not be padded after the surgery. If padded, it may be left for a few hours after the operation.
There may be blood in the tears and the eyes may be crusted together in the mornings after waking up for a few days post-operation.
Eye redness may last for a few weeks after the procedure.
Eye pain or discomfort (e.g. a prickly, irritated sensation) is expected for a few days so the patient is advised to take oral painkillers if required.
Double vision may be experienced in the first few weeks, this should improve in most cases.
Eye drops containing an antibiotic and anti-inflammatory agent will need to be instilled a few weeks after the operation.
Avoid swimming and strenuous physical activity for at least four weeks after the operation.
Follow-up clinic visits will be arranged after the operation where eye alignment, vision and eye pressure will be assessed.
