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Squints

Learn more about the causes of squints and how to treat them.

Squint in adults – What is a squint?

A squint is when one eye wanders or turns, so that it does not work with the other eye. The eye may turn inwards or outwards, or more rarely upwards or downwards. The eye may turn all of the time or only sometimes, for example when tired or concentrating. The technical term for squint is strabismus

 

What causes a squint?

There are many causes for squints, and you should talk to your orthoptist or eye doctor about the cause in your case. Some of the most common causes are as follows:

Some people had a squint which was treated as a child but which has come back over time. Some people have had a tendency to squint for a long time, which they have been able to control. Over time it may get more difficult to control the eyes so that a squint develops. Some squints develop as the result of an accident or illness that has affected the muscles which move the eyes.

 

Why does a squint need to be treated?

Squints can be treated to improve the appearance of the eyes and/or to help double vision or eyestrain caused by the squint.

 

How are squints treated?

  • Eye exercises to improve the control of the eyes can help some squints. In some cases glasses may improve the squint. In particular glasses for long
  • -sight can correct some inward turning squints. Prism glasses can help to control double vision and eyestrain.
  • Surgery to change the position of the muscles which move the eyes can improve or correct some squints.
  • Injections of botulinum (Botox) into an eye muscle can improve some squints but the effect is usually only temporary.

*For some people there is a choice of treatment. In others the orthoptist’s tests may show that only one of the above treatments is likely to be helpful. Your orthoptist and ophthalmologist

 

What happens during an operation for squint?

There are six muscles that move each eye. The muscles are attached to the surface of each eye, under the white of the eye. By moving the position of a muscle, it can be weakened or strengthened to straighten the eye. The muscle is reattached to the eye using stitches which dissolve in about six to eight weeks and which do not usually need to be removed. Stitches may also be needed in the clear layer which covers the surface of the eye (the conjunctiva). These usually fall out in the first four to six weeks after the operation but occasionally need to be removed. The operation is on surface of the eye and the eye is not removed. Often two eye muscles need to be operated on to correct a squint and the operation may need to be on one or both eyes. The operation is done under general anaesthetic.

Your eye doctor may recommend an ‘adjustable operation’. This means that the muscle is operated on as usual under a general anaesthetic but instead of fully reattaching the muscle to the eye at the end of the operation, the muscle is loosely re-attached. When you wake up after the operation, the position of the muscle can be adjusted slightly to straighten the eye as much as possible and the muscle is then fully re-attached. Local anaesthetic drops are put into the eye first so that the adjustment is not painful. Not everyone will benefit from an adjustable operation but if the doctor thinks that you would they will explain this fully to you. Once you have all the information you can decide

whether you wish to go ahead with an adjustable operation.  Squint surgery is generally a day case only.

 

What are the risks of the operation?

Squint surgery is done under a general anaesthetic. Any risks from this are very small if your health is good. The operation is on the surface of the eye so any risk of damage to the eye or to the vision is very small, provided your eyes are healthy. The eye will be quite uncomfortable for a few days after the operation, but should not be really painful. The discomfort is often greater if you have had a previous squint operation on the same eye muscle.

The white area of the eye where the operation was done will look red after the operation. This will improve in the first couple of weeks after the operation but may take a few months to settle. Rarely some redness may be permanent. As with any operation, squint surgery carries a small risk of infection. This is usually easily treated, but there is a very small risk (1 in 50,000) of infection, which could permanently affect the vision. Sometimes more than one operation is needed to correct a squint or double vision. In most cases this is because the first operation helped but did not fully correct the squint. Occasionally, a second operation is needed because the first operation made the eye turn in the opposite direction.

In some people, the operation straightens the eye well. Some people who did not have double vision before the operation notice temporary double after the operation occasionally last long.

 

How long before I can get back to normal after a squint operation?

On average people need one week off work/full activities after a squint operation, however this does vary. People who do heavy manual work may need two weeks off work after the operation. You will be given eye drops to use every day for two weeks after the operation, to help the eye(s) to heal. You should avoid sports and strenuous activity for two weeks after the operation, and you should not swim for four weeks.

You can start driving again as soon as you feel safe and confident to do so.

Contact lenses should not be worn in the operated eye(s) for at least one week after

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