Strabismus

Types of strabismus

Strabismus, or squint, is a misalignment of the eyes where they are not pointing in the same direction. This misalignment can be where one eye drifts outwards (exotropia) or inwards (esotropia) or a vertical misalignment, where an abnormal eye is higher (hypertropia) or lower (hypotropia) than the normal eye.

Some people have small misalignment of the eyes that may not be visually obvious, yet it can prevent the two eyes working together and even cause double vision, which can be completely disabling in the daily life.

Psychological effects of strabismus

In addition to visual disturbances, patients with strabismus may be concerned about their eye misalignment affecting their appearance and quality of life. It’s not uncommon for both children and adults to experience psychological distress associated with their strabismus. Therefore, it is important for the health practitioners who see them to understand how strabismus can have multiple implications for different aspects of their lives.

Causes of strabismus

In children, strabismus could be the result of a refractive error (focusing abnormality, particularly uncorrected long-sight), eye muscle imbalance, injury, or it can run in families. In some cases, squints that have been corrected during childhood could appear in adulthood.

Strabismus treatment for children

If a squint is left untreated in young children, lazy eye (amblyopia) can develop where the affected eye is not able to build a strong link with the brain, resulting in a reduced vision. So, most squints in children need to be assessed as soon as possible.

Treatments include glasses, Atropine drops, Botulinum Toxin (Botox) injections and eye exercises to control some intermittent squints in older children. Children with a lazy eye may need to wear an eye patch to improve their vision in the affected eye. In some cases, corrective surgery may be undertaken.

Strabismus surgery, in most cases, is very straightforward. The commonest form of strabismus procedures involves moving the position of or shortening the eye muscles to alter the alignment of the eye. Certain forms of strabismus surgery can be more complicated, but we have a high level of experience dealing with complex forms of strabismus.

Squint surgery at Moorfields Private is a day-case procedure, and patients should be in and out of hospital on the same day. Often one operation is effective, but some children may need further surgery.

Can strabismus be treated in adults?

There is a misconception that strabismus can’t be treated in adults. Many adult patients with squint either don’t know there is treatment available or may have been told that nothing could be done for their squint. It’s very important GPs and optometrists are aware of the treatment availability and can refer them.

Most adults who are concerned about the appearance of their squint or double vision can be helped by squint surgery.

Some adults for whom the surgery is not an option because of their previous surgeries or because of the type of squint they have, may be offered Botox injections to help their eyes become better aligned and reduce blurred or double vision. The injections have a temporary effect, which could last from 3-4 months up to 2 years, depending on the individual.