It is important that a squint is treated as soon as possible after being detected. If it is not treated, vision problems, such as those caused by a lazy eye (amblyopia), are likely to get worse or could become permanent. Treatment is most effective in very young children.
Several types of treatment are available for squints, including:
- eye exercises
- botulinum toxin injections
- corrective surgery
These are described below.
Glasses are one of the most common treatments for squints. They can be used to correct the vision problems (refractive errors) that may be causing the squint, such as:
- short-sightedness (myopia)
- long-sightedness (hyperopia)
- an unevenly curved cornea (astigmatism)
Children’s glasses will have plastic rather than glass lenses to reduce the risk of possible injury.
In some cases, it may be possible to treat a squint using special eye exercises that help the eyes work together.
Botulinum toxin injection
Botulinum toxin may be a treatment option for some types of squint.
It can be injected into one of the muscles that move the eye. The injection temporarily weakens the injected muscle, allowing the eyes to realign.
The effects of botulinum toxin usually last around three months. After this time, the eyes may stay in position or they may go back out of alignment and require further treatment.
Children will usually be given medication to help them relax (a sedative) before having the botuli-num toxin injection. Botulinum toxin injections can cause temporary side effects such as:
- a droopy eyelid (ptosis)
- the eye “drifting” slightly, so it appears as if one eye is looking up
- double vision
- some bleeding over the white part of the eye
If treatment doesn’t work, surgery may be rec-ommended. Surgery can be used to:
- improve the alignment of the eyes (and therefore their appearance)
- help the eyes work together
Surgery involves moving the muscles attached to the outside of the eye to a new position. It may be necessary to operate on both eyes to balance them, even if the squint is only in one eye.
The operation is carried out under local anaes-thetic in adults and usually takes less than an hour to perform. It is carried out as a day case, so the patient can go home the same day.
During the operation, the eye will be kept open using an instrument called a lid speculum. The ophthalmologist (eye care specialist) will detach one part of the muscle connected to the eye and will either move it backwards to weaken the pulling effect, or shorten it to increase the pulling effect. Once the correction has been made, the muscles will be sewn back into place using dissolvable stitches.
Risks of surgery
As with any kind of operation, there is a risk that problems will arise due to surgery to fix a squint.
If you or your child care having surgery for a squint, ask your ophthalmologist (eye care specialist) to discuss possible risks with you before the operation.
Risks of eye surgery include:
- The possibility of further surgery, which is sometimes needed if the squint is severe.
- The eye may remain red for a long time after the operation. This is rare, but it may be caused by scar tissue forming on the surface of the eye.
- Double vision may occur after the opera-tion. This usually resolves after a week or so.
- The squint may recur and another opera-tion may be needed.
- One of the eye muscles may slip after the operation, although this is very rare. This makes the eye point inwards or outwards (depending on which muscle has slipped) and can impair eye movement. It may need to be operated on again.
- In rare cases, the inside of the eye can be damaged during surgery.
- An infection may develop after the operation. This is possible with any type of surgery. In the case of eye surgery, eye drops or ointment can be used to reduce the risk.
Recovering from surgery
It can take several weeks to fully recover from corrective eye surgery. After surgery, you may have a sore eye for a few days. The pain can be treated using simple painkillers. Children under 16 years of age should not be given aspirin. If the pain does not improve, speak to your eye care specialist.
Following eye surgery, a pad may be put over the affected eye, which will usually be removed be-fore you are discharged from hospital. There is no need to wear a patch or bandage at home and you can return to daily activities, such as reading, as soon as you feel able to. The aim is to get the eyes working normally as quickly as possible.
(The procedure can be carried out under general anesthesia for children, which we currently do not perform in our clinic.)