Squint or crossed eye is a condition where both eyes do not move together. One eye deviates either inwards, outwards, upwards or downwards while the other eye remains straight. It may also be alternating between the two eyes. It is a condition which often runs in the family. It can affect one in 50 children under five years old and a successful operation should mean your child's eyes move together. Squinting in adults can also occur if the nerves to the eye muscles, or the eye muscles themselves, are not working properly causing double vision.
Squint correction is carried out under anesthesia and usually takes about 40 minutes. The surgeon makes a small cut in the surface membrane of your eye and then separates one or more eye muscles from the surface of the eyeball. Using small dissolvable stitches, we then reattach the muscles, making them tighter or looser than they were before, depending on the correction that needs to be made. Once the operation is complete the eyes will be covered by a patch and clear plastic shields and you can rest for a while before departure.
At Aayush we ascertain the patient’s perception of the problem. Is a single eye crossed or deviated outward? Which eye is involved? Was the onset gradual or sudden, and has the problem occurred before? Is the problem stable, improving, or getting worse? Does the patient have diplopia, asthenopia, headaches, or other symptoms? Are there associated signs or symptoms such as ptosis or variability that might suggest myasthenia gravis? Are there any neurologic concerns? Finally, an understanding of the influence of the condition on activities of daily living is important in helping to counsel the patient regarding treatment recommendations and prognosis.
Key areas of discussion may include effect on work, driving, relationships, social life, feeling of well-being, and concern for the future. Review of prior treatment records can be helpful, though records from childhood are often not available. Lack of availability of previous records should not preclude treatment, including surgery.
A comprehensive eye examination, with special emphasis on the ocular motility examination, is indicated for any adult patient for whom strabismus surgery is planned. Examination needs will vary from patient to patient and a one-size-fits-all approach is not appropriate.
Ocular motility evaluation should include assessment of binocular alignment in the primary position at distance and near, and evaluation of ocular versions at a minimum. For patients with incomitant strabismus, such as that due to a cranial nerve palsy or restrictive strabismus, assessment of ocular alignment in the secondary and tertiary positions of gaze may be helpful.. In general, quantification of the size of the patient’s deviation should be done with significant refractive correction in place. The specific techniques of ocular motility evaluation are well known to practicing ophthalmologists, and the reader is referred to standard texts for this information.
Numerous ancillary studies can be performed on a patient with strabismus. This section covers some of the more common tests that are readily available.
It is often useful to determine if a patient has the potential to fuse, especially if surgery is anticipated. This can be determined with prism correction of the deviation or with an amblyoscope
Patients with good motor fusional amplitudes are more likely to be able to fuse following surgery.
Each of the cyclovertical muscles has a complex set of primary and secondary actions including torsional ocular movements. Therefore, testing for the presence of a concurrent cyclotropia is important in the management of a patient with vertical strabismus. Cyclotorsion can be estimated objectively by evaluation of the fundus for evidence of cyclotorsion and can be measured subjectively with double Maddox rods. Use of Double Maddox Rod Test to Assess Cyclotropia Binocular Visual Field Testing This test can be useful in quantifying the size and location of the field of single binocular vision in a patient who is able to achieve fusion in some positions of gaze. Binocular Visual Field Assessment Using a Goldmann Perimeter Evaluation of Limited Ductions
Forced duction testing can be performed in the office with the patient awake or in the operating room prior to the start of surgery.
Laboratory testing is indicated when we believe that the patient’s strabismus is either caused by or complicated by the presence of systemic disease. The onset of an acute cranial nerve palsy, for example, should prompt consideration for evaluation of the patient for diabetes, hypertension, and/or other microvascular disease. Testing for myasthenia gravis should be considered for patients with variable strabismus, especially if associated with ptosis and/or evidence of systemic muscle weakness. The presence of other concurrent neurological signs or symptoms should prompt consideration of neuroimaging and/or neurological evaluation, performed in collaboration with the patient’s primary care physician.
Your child should be able to go home the same or following day and you will be advised when they can return to normal activities. Your child will need regular follow-up appointments with the surgeon and eye specialist. Most children make a good recovery.
It has almost no risks. Most patients do not suffer any complications or side effects but we should mention those complications that can occur: