SQUINT

 

  • Incorrect Balance of the muscles moving the eyes.
  • Faulty Nerve Signals to the eye muscles.
  • Focusing Faults of the eye.
  • It could also be due to some brain disorder leading to poor coordination between the eyes.

Squint causes the eyes to either Diverge(Turn out), Converge (Turn in) apart from this, squint could also cause the eyes to turn up or down. It is a basic misalignment which could occur in any direction.

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What are the various categories of squint?

 

Squint is categorized into various types on the basis of direction of squinting eye:

  • Eye that turns inwards is esotropia
  • Eye that turns outwards is exotropia
  • Eye that turns upwards is hypertropia
  • Eye which turns downwards is hypotropia

SQUINT Treatment

 

Correcting Amblyopia (Lazy Eye)

  • Amblyopia correction is made by patching the good eye for few hours every day so as to equalize the vision in both eyes. This can be done before the age of 10.

Correcting Refractive Errors

  • Some squints can by corrected by spectacles alone. Our specialist would guide you on the best solution.

SURGERY

  • It involves operating on the eye muscles so as to align both the eyes together in all direction. One or more operations may be needed for cosmetic correction and creating the perfect vision and binocularity.

What are the Symptoms and signs of squint?

 

The typical symptoms that could signify a neuro-ophthalmological problem include:

Most obvious and common symptom of Squint is that two eyes always point in opposite directions. Some squint patients try to orient their heads and faces in a specific direction in which their eyes can be brought in required normal orientation. Some time the patents feel confusion and double vision. This eye condition some time causes poor vision, blurred vision as well as total blindness.

The primary sign of squint is that the eye is not straight. Then there could be faulty depth perception which could be present. It could also cause confusion or double vision in children.

Causes of Squint

 

  • Congenital and HereditarySquints in a newborn child could be present at birth and it could stem from a history of similar problems in the family.
  • Nerve Damage Squinting of the eye can also be attributed to lesions on the cranial nerve or suffering an injury to the nerves during a difficult delivery.
  • Long SightednessSometimes a squint can be developed due to long-sightedness as the eyes have to ‘over-focus’ in a sense to see clearly and the brain might respond by switching images from one eye to the other resulting in a weakening of the muscles
  • Childhood IllnessSquint in the eyes can also be attributed to illnesses and viral infections like measles, chickenpox etc or genetic factors like Noonan Syndrome.
  • Refractive Errors Many a time, squints in the eyes could also develop due to refractive errors of the eye like myopia, hyperopia or astigmatism and this is because the eye tends to turn inwards to focus better

How to tell if my Child has a squint?

 

Children are either born with a squint or develop it in early childhood. Most kids develop this condition between the ages of 1 to 4 and in rare cases up to the age of 6. Most of the times it is hard to tell in newborns as their eyes wander and cross occasionally during the first few months.
However, eyes should straighten out by 4 to 6 months.

Sometimes, however, it is very easy to spot a squint as the eyes will be pointing in very different directions. In addition to this, you could also notice a squinted eye(s) when kids focus on something close like a toy or a puzzle.

Eye squints produce very little discomfort barring the occasional double vision or blurry vision but sometimes, kids won’t understand it all. It is generally noticed by others such as relatives or a health care professional.

Types of Squint

 

The different types of squints are described by the way the eye turns. These can be categorized as follows:

  • Hypertropia: A squint where the eyes tend to turn upwards.
  • Hypotropia: Squinting/Turning of the eye in a downwards direction
  • Esotropia:Turning of the eye inwards
  • Exotropia: Condition where the eyes turn outwards
  • Concomitant squint which refers to squint in which angle of severity is always the same in every direction.
  • Incomitant squintwhich refers to squint in which angle of severity can vary in every direction you look

Strabismus or squinting is a condition which is better treated early on in the life of the child. Previously, it was believed that beyond a certain time period (called critical time) strabismus was untreatable. However, with modern corrective techniques, squints can be treated at any time.
It is advisable however that you show up for constant eye checkups if you suspect your child may have squints, it becomes easier to correct it in early stages of life.

Symptoms of Strabismus(Squint)

 

Strabismus is one of those vision imperfections which could produce very little to no symptoms and it could also show a lot of symptoms. It is not easy to figure out whether or not a child has the vision impairment or not.

The most obvious and noticeable symptoms will include eyes not being perfectly aligned in a line. In addition to this, there are a few pointers on as to how to determine if the kid has a squint or not.

  • Blurred/Unstable Vision: Images are not clear
  • Double Vision:Seeing two sets of images of the same objects
  • Lazy Eye: Where the brain starts ignoring signals from one eye in order to avoid double vision
  • Split Vision: Like seeing perfectly from one eye but only being able to see half an image from the other eye
  • Eyestrain
  • Fatigue
  • Headaches

Diagnosing Eye Squints

 

Eye Squints are sometimes noticeable, but many a time there are very subtle and they can develop later on so, it is easier to get an eye check up and determine whether or not your child has it or not.

  • Diagnosis Method:To diagnose whether or not an individual has Strabismus, ophthalmologists will perform a test called the Hirschberg Test or, the Hirschberg Corneal Reflex Test. In this test, after dilating the pupils with eye drops, the doctor shines a light onto the eyes and makes observations on where the same light is being reflected back. If the light goes through to the centre of both corneas, the eyes are well-aligned. If not, the patient most likely has squints or Strabismus.

How to cure Squinting?

 

Squinting eyes can give an individual a feeling of being different from others which might give young children self-doubt and over-sensitivity towards their appearance. Apart from the mental and psychological challenges, long-standing squints in the eye could hamper day-to-day activities like reading, driving etc and also could lead to some permanent visual impairments. Thus, it becomes essential to address this issue as soon as it is diagnosed.
Here are some corrective measures that can be used to cure squinting:

  • Corrective Glasses:If long sightedness or any other refractive errors is what is causing the squinting, it can be corrected by glasses.
  • Eye Patch/OcclusionEye patches can sometimes correct squints in the eye. The patch is worn over the good eye to enhance the vision of the eye with a squint.Eye patches can sometimes correct squints in the eye. The patch is worn over the good eye to enhance the vision of the eye with a squint.
  • Botox (Botulinum toxin) Injection
  • Exotropia: Condition where the eyes turn outwards
  • Concomitant squint which refers to squint in which angle of severity is always the same in every direction.
  • Sometimes, doctors cannot find an underlying cause for the eye squints and the symptoms start appearing out of the blue. In this procedure, Botox is injected into a muscle on the surface of the eye. The Botox temporarily weakens the muscle injected which can assist in proper alignment of the eyes.
  • Eye Drops and Eye Exercise – Special eye drops can help correct squints in addition to this, some eye exercises can go a long way to help with this eye condition.

Eye exercise also called home-based pencil pushups (HBPP) can be done to improve the condition. Here are the steps to the exercise:

  • Take a pencil and hold it at a distance as much as your arm’s length aligning it with the mid-point between the eyes.
  • Move the pencil towards your nose and try maintaining a single image of the pencil.
  • Move the pencil towards the nose until there is a point where the pencil is no longer a single image
  • Hold the pencil at the nearest point where you can see a single image.
  • If you have troubles retaining a single image, try the procedure again.
  • Oral Medication- It might be necessary based on what type of squints you have.
  • Surgery – If all other options don’t seem to work the last resort option has to be surgery.

Benefits of the Surgery

 

  • Improved Appearance
  • Improved Peripheral Vision
  • Improved depth Perception
  • Double Vision/Blurry Vision is corrected.

Preparing for the Strabismus Surgery(Squint Surgery)

 

There will be a pre-operative assessment i.e. Pre-op. In the pre-op the doctors will make sure that you are fit for the surgery and doctors will be open to clarify any questions.
Doctors will assign you a time slot for the surgery and advise that you stop eating and drinking some time before the surgical procedure.

Manage your logistics of getting home because you will be able to go home the same day (outpatient). It is advisable to have someone drive you back from the hospital as you will be drowsy after the surgery.

Surgical Procedure for Correcting Strabismus (Squint) Surgery

 

During the surgical procedure to fix the squint in the eye:

  • Eye Pain- It might feel like there is grit or sand in your eyes. Taking painkillers might help. However, youth under 16 should not be administered aspirin.
  • Red Eyes- Red Eyes can last up to 2 months. You could have a little blood in your tears
  • Itchy Eyes- This is caused because of the stitches dissolved in the eyes. This itchiness will subside in a few days. Avoid excessive scratching of the eyes
  • Double Vision- Double vision passes after a maximum time-frame of 7 days

After the Operation (Post-Op)

 

A pad is put over the treated eye after the operation.
After the operation, it is very likely that your eyes will be sore for some time (probably a few days). Your surgeon may provide you with some painkillers and eye-drops to ease the pain and discomfort.

The Doctors might ask you to attend a few follow-ups visits to check the progression of the correction. Do not hesitate to contact your health care professional if you start experiencing some severe or long-lasting effects from the surgery.

Risks involved the Surgery

 

Risks involved with the surgery include:

  • A requirement of another corrective surgery to fully address the squint. This is pretty common and even more so if the squint is severe
  • Permanent Double Vision – One of the risks with the surgical procedures, this might require corrective glasses to fix
  • Infections- Cyst(Fluid Buildup), Abcess(Pus Buildup), around the eye these might require treatment with antibiotics or some procedure that helps drain out the pus or fluid.
  • Loss of Vision- Extremely Rare Cases

Our Team

Dr. Shweta Jain

“Dr. Shweta Jain is a well-known ophthalmologist who has been contributory providing quality eye care. Her ethical skills and knowledge in MBBS plus Ophthalmology made her write thesis on Comparative evaluation of fundus fluorescein angiography with spectral domain OCT in patients of age-related macular degeneration. With the guidance of Dr, Rajiv Mohan. She has great surgical experience such as  ECCE with PCIOL, Anterior vitrectomy etc. Currently, she is Pursuing FRCS (Glasgow).”

Dr. Rajiv Mohan

“Dr. Rajiv Mohan is a renowned ophthalmologist who has been instrumental in providing quality eye care and education in Northern India, both in private and charitable sectors. He received his medical degree from University College of Medical Sciences, Delhi in 1985 and Masters in Ophthalmology from Karnataka University in 1989. In 1990 he did his advanced medical training in the field of vitreo- retina from England and got his FRCS (Glasgow) in 2002. “

Dr. Sanjiv Mohan

“Qualification: MBBS from SMS medical college Jaipur
MS from Dharwad university, Belgaum.
Trained for higher surgical training in Scotland U.K for 2 years.
FRCS
Experience: Dr. Sanjiv Mohan has an experience of over 18 years as an Ophthalmologist”

Frequently Asked Questions

 

1. What are the usual symptoms indicating Cataract?
There is a painless, gradual decrease in vision. Early cataract is associated with difficulty in reading in normal light conditions, and extra illumination is required. Excessive glare and reduced sharpness can make night driving difficult. Some experience a rapid change in the number/power of glasses.
In advanced cases there is a complete loss of sight and lens becomes pearly white in colour.
If you experience any of the following issues, schedule an appointment with your eye doctor immediately:

  • Cloudy or blurry vision
  • Double vision (diplopia)
  • Fading of colours
  • Seeing halos around lights
  • An increased sensitivity to glare
  • A distortion of vision that makes objects appear as if you’re looking at them through a veil.

2.What are the problems associated with Cataract?
There is a painless, progressive reduction of vision. Initially, some help is achieved by changing the spectacle number, but in advance cases, the spectacles also prove to be ineffective.
Cataracts are the world’s leading cause of blindness, accounting for approximately 42 percent of all cases of blindness in all the countries, luckily its easily treatable in the present age through a simple surgery.
3. Who is normally affected by Cataract?
Cataract is a long-term problem that usually starts developing around the age of 40 and intensifies by the time an individual attains the age of 50 to 60. It is also caused by eye-trauma, long-term diabetes, corticosteroid medications or radiation treatments.
Some infants are also afflicted by cataract, which is caused as a result of infections during pregnancy. The disorder can also be a symptom of metabolic disease affecting the body’s processing of carbohydrates, amino acids, calcium or copper among infants and young kids. If left untreated, cataracts might also lead to blindness.
4. How long does it take to recover from the surgery?
There is usually no visible scarring, but at times the white of the eye can have a degree of redness.You may go home with an eye pad and shield, or just a shield. The pad can be removed after the first hour. The shield should be worn at night for the first week.
The eye may feel gritty, and sometimes you may experience some mild headache. These symptoms are common. The discomfort should rapidly improve over the next 24 hours. There should be no worsening of your symptoms. If your discomfort or a headache should deteriorate, you should contact your doctor immediately.
Your vision will normally be much better on Day 2. Sometimes there can be some blurring or misting in the eye, but this should improve over the course of the day. If you feel your vision is becoming more blurred, contact your hospital immediately.

If you take part in a sport that risks a poke in the eye, you should discuss returning to these activities with your surgeon before the operation. You should not go swimming for the first 2 to 4 weeks to minimize the risk of infection. When cycling in the first few weeks following surgery, keep your sunglasses on to reduce the impact of dust.

5. When can I return to work?
Every person recovers differently and has different needs. Surgery normally has a very quick recovery, and the majority of individuals can normally get back to work almost immediately.

Jobs that are more physically demanding and involve exposure to liquids or dust might require a more graduated return to full activities, but are best discussed with your surgeon.

6. Will I need to use glasses after surgery?
The lens which is placed in the eye is of a fixed power. The power of the lens for a particular eye is calculated with the help of an eye ultrasound. After surgery, routine distance activities can be carried out without glasses. For reading, glasses would be required.

You may opt to choose for lenses which provide you vision for distance and near. In such cases, dependency on glasses is reduced.

7. Is there a lens which can give me good clarity for both distance and near vision?
Patent protection is territorial right and therefore it is effective only within the territory of India. However, filing an application in India enables the applicant to file a corresponding application for same invention in convention countries, within or before expiry of twelve months from the filing date in India. Therefore, separate patents should be obtained in each country where the applicant requires protection of his invention in those countries. There is no patent valid worldwide.

8. I have both cylindrical and spherical number. Can both be corrected by cataract surgery?
Cataract surgery has now become a refractive surgery, and the goal is not just to remove the opacified cataractous lens but also to reduce dependency on glasses.

Routine surgery can only correct the spherical component of the eye leaving behind the cylinder power which has to be later corrected by additional prescription glasses.

With advancements in surgical techniques and IOL (artificial lens) designs, today both spherical and cylinder components of the eye can easily be corrected with the highest precision.

The cylinder component in Cataract Surgery can be corrected by three ways

  • LRI or Limbal Relaxing Incisions: In this technique, a Femto Laser is used to give highly precise incisions at the periphery of the cornea to induce cylinder correction. Since these incisions are given by a laser, it can only be coupled with a Femto Cataract Surgery.
  • Toric Lenses with Verion Digital Axis Marking: Toric lenses are special lenses which have both cylinder, and spherical component build in one lens. Since cylinder axis varies in individual eyes, the lens has to be aligned to the specific axis of the individual. In such cases, even a minor deviation from the original axis can cause significant disturbance in final visual outcomes. Now with the introduction of Verion Digital Axis Marking system, these toric lenses can be aligned with outmost precision, up to 1 degree.
  • Toric Lenses with Manual Marking: As discussed above, the final visual outcome in a toric lens depends on how precisely it is aligned to the original cylindrical axis of the eye. Since the manual markings cannot be as precise as digital markings, the manual system may give slightly inferior results compared to the digital system.

9. Can an immature cataract be operated?
It is easier and safer to operate on an immature cataract. As it matures, it tends to become harder requiring more energy to do the same job. Beyond a certain limit, excess energy may cause harm to the eye.

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