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SQUINTS AND THE LAZY EYE: Squinting is a common childhood disorder and can also affect adults. A squint is present when the eyes are mal-aligned, with each eye looking in a different direction. When the eyes look inward and are "cross-eyed", the squint is called an esotropia, and when the eyes look outward, the squint is called an exotropia. It may present with double vision in the older child or adult. Young children and babies do not complain of double vision when they have a squint, due to the fact that their brain suppresses the input from one of the eyes. This may lead to the development of a lazy eye, and if the condition is not treated in time, can lead to permanent visual deficit.
There are different types of squints, each with a different cause. The most common causes include:
1: Congenital: The baby is born with the squint, and though there are many theories, the real reason for the squint is unknown. It is important to realize that babies with squints will not outgrow this condition, and that these children should be under the care of an ophthalmologist, so that the correct treatment (which may include surgery), can be started in time.
Another reason for early investigation by an ophthalmologist is that the squint may be due to a tumor inside the eye, called a retinoblastoma, which may be curable if treated early enough.2: Refractive error: Farsightedness may be the cause of a squint. This can be explained by the fact that the reflex that increases the focusing mechanism of the eyes also causes the eyes to converge. In a farsighted person with a squint, this reflex is overactive, and squinting occurs even when looking at distant objects. This type of squint can usually be improved with the right spectacle correction, and does not need to be treated surgically.
3: Brain damage and also damage to the nerves themselves that supply the muscles of the eye may cause a squint. This usually happens in patients who had severe trauma to the skull, or after some types of stroke.
4: Local conditions of the eye and surrounding bony orbit can cause squints, and these include paralysis of the muscles of the eye, fractures of the bony orbit, and even tumors of the eye.
Question: What is the importance of treating a squint?
Answer:
1: The baby can develop a so-called lazy eye or amblyopia. Because the patient with a squint initially has double vision he or she compensates for this double vision by ignoring the vision in the squinting eye. If this happens in a child and continues for long enough, the normal development of the eye is inhibited and the child can develop permanent visual impairment. As a general rule, the younger the squinting patient is, the sooner he or she can develop a lazy eye, but also the easier it is to treat this condition.2: It is cosmetically and socially unacceptable, and may lead to the child being ridiculed and laughed at, which in turn may lead to psychological problems and impaired normal general development of the child.
3: The squint can be caused by serious (and mostly treatable) pathology inside the eye, such as a tumor, as mentioned above.
Question: What should you do if you notice that your child has a squint?
Answer: It is very important for you to realize that your child will not outgrow the squint, and that he should be seen by an eye-specialist as soon as possible.
If your child has a persistent squint two months after birth he or she should be referred to a eye specialist. Eye-exercises and other orthoptic treatments have no place in the management of most types of squints, and this should be considered only in special circumstances if the ophthalmologist deems it necessary as a temporary measure.
Question: What will the eye specialist do?
Answer:
1: Look for the cause of the squint.
2: Examine the patient for amblyopia or a lazy eye and treat him or her for it if necessary.
3: Aim to obtain binocular or three-dimensional vision after successful treatment, which includes either the prescribing of glasses, occlusion of the good eye to stimulate the weaker lazy eye, or surgery to align the eyes.
In summary, it must be stressed that someone with a squint should be under the care of an ophthalmologist. It is not a condition to be ignored, especially in young children, or if of sudden onset in adults.
If you have any further questions regarding squints or lazy eyes, please consult your eye specialist.