Squint eye or strabismus can be found in both children and adults, with each of the categories developing it due to a variety of reasons. With squint eye, the key is early detection and treatment, for the benefit of vision as well as the self-esteem of the patient. Dr Norazah Abdul Rahman, a Consultant Ophthalmologist and Paediatric Ophthalmologist & Strabismus at ParkCity Medical Centre, shines the light on the importance of early treatment of strabismus, especially for children.
By Esvaren Sekar
Strabismus is the medical term for the condition where the eyes point in different directions, resulting in misalignment of the eyes. There are few different types of squint: convergent squint (esotropia) when one eye turns inward, divergent squint (exotropia) when it turns outward, and vertical squint if the eye turns up or down. These types of squint could always be present or only appear intermittently at certain times.
Squint Eye in Children
“Squint eye usually appears in children before five years old, but it can also appear later. And it is not limited to children either, as adults can develop strabismus too. Though the main reason for strabismus is unknown, children with disorders that affect the brain such as cerebral palsy, Down syndrome, hydrocephalus, and brain tumour have higher chances of developing strabismus,” says Dr Norazah.
In Malaysia, one of the most common cases of strabismus is intermittent exotropia, a condition which allows patients to have straight, aligned eyes when they’re focused, but an eye will begin drifting away intermittently when they are ill, tired or daydream. Once they focus again, the eye will immediately go back to the normal position. Accounting for up to 30 per cent of all ocular misalignment in early childhood, intermittent exotropia starts to develop in a child between one and four years old.
In addition, another common case is undiagnosed refractive error among children causing acquired squint. For example, when a young child suffers from long-sightedness and has problem focusing on items that are near, they will start forcing their eyes, causing the eye to squint inwards.
“With children, it is very important for parents to keep an eye out for these signs. Children can be born with squint (known as congenital or infantile squint) and we can detect it as early as four months after being born. Most squints in children need to be evaluated as soon as possible to ensure the vision is protected and to improve the chances of successful treatment. Treatment is to improve eye alignment, and may involve glasses, eye exercises, prism, and eye muscle surgery. If your child has a lazy eye, they may even need to wear an eye patch to improve vision in the affected eye.
Squint Eye in Adults
For adults, squint eye could either be caused by issues that occur later in life or due to hidden squint eye during childhood that was left untreated.
“In younger population, we often find decompensated squint, which happens when an adult has squint at an early stage of life, but they managed to control it. So, the squint becomes masked. However, throughout their life, these adults might encounter any events and the squint becomes decompensated causing it to develop again. Most of the time it is trauma related, such as a motor vehicle accident,” explains Dr Norazah.
Apart from that, stroke also plays a part in squint eye in adults, as the nerve that controls the movement of the eyes in the brain becomes affected. A sign of squint eye in adults is also the appearance of double vision.
“Most adults who grow up with squint eye due to a lack of awareness. Adults with strabismus may have lack depth vision (3D) or stereopsis, which limits career opportunities. Furthermore, growing up with squint eye may cause the child to be bullied, resulting in low self-esteem as an adult,” says Dr Norazah.
Treating Squint Eye
Squint eye in children must be corrected early. “When a child has squint, we first look at non-surgical options for squint correction. For example, if they have refractive error, we give them glasses. A lot of children have good outcomes with glasses and the squint disappears. Some still have squint with glasses but decreases significantly, and we try to correct residual squint with surgery. In some cases, corrective surgery may be undertaken to correct double vision or, in young children, for the two eyes to work together to achieve depth vision,” explains Dr Norazah.
Meanwhile, adults with squint eye may receive glasses with prism if the angle of their squint is small. Nonetheless if they suffer from headaches or double vision, surgery is the go-to step.
“It is important for parents to not be afraid of sending their child for surgery if it is needed to treat squint eye. Not only is it very safe, but it will also help the child grow up to their full potential,” assures Dr Norazah.