Squint is the misalignment of the eyes, wherein both the eyes point towards different directions. The misalignment may be constant for a few, while it may intermittently occur for some others. The deviation of the eye may be in any direction — inward, outward, upward or downward. Squints may be found in isolation, without any other eye-abnormality in children, in the first one to two years of their lives. They are also associated with high-spectacle power or low vision due to other eye abnormalities like cataract, glaucoma, retinal problems, tumours or mass lesions within the eye ball or in the bony orbit. Sudden onset of squints should always raise a suspicion of a neurological abnormality or an active inflammation in the orbit, which needs urgent medical attention.
Visual development in the brain takes place in the first four to five years, with stereoscopic vision (ability to see in 3D) developing in the first two years. After these first few years, visual development in the brain ceases to occur.
We all need 3D vision to function — to assess depth, distance, and speed. If the eyes are not perfectly aligned, the brain cannot see in 3D. As this faculty develops in early years of our lives, a child suffering from squint needs to be treated at the appropriate time. Otherwise, a condition called amblyopia or lazy eye may occur, which eventually leads to maldevelopment and low vision.
If the squint is treated early, a child can gain optimal vision. A child who has a squint eye in the first year of life, should ideally be treated as soon as it is noticed by the parent. The aim is to give maximal visual output, and not just align the eyes. At a later age, the visual impairment cannot be rectified and the correction of squint will serve a purely cosmetic purpose. Delay in treatment converts a functional problem into a purely cosmetic blemish. The biggest myth that I fight as a strabismologist is that any surgical intervention should be done when the child is “old enough”.
In spite of repeated warnings, parents and guardians tend to go on the back foot when surgical options are discussed. Also, one needs to understand that not all squints need surgery. Some will need just spectacle correction or require orthoptic exercises to strengthen the muscles that move the eyeballs. Surgery, if required, is done on the muscles that move the eyeballs. The surgery is usually a one-day procedure that does not require any over-night hospital stay. The surgery leaves no visible scars, and is a safe and effective procedure.
Correction of squints, in addition to being valuable for vision, often changes the behaviour of children. I have seen children blossom from introverted personalities to bright, chirpy, extroverted children once the squint is treated. Often, a visible abnormality can have a psychological impact on a child, compounded by peers who tease.
A child with a squint needs a specialist to screen him or her and give the appropriate treatment at the right age before it becomes “just a cosmetic problem”.
Chaudhry is a Senior Consultant, Ophthalmology & Refractive Surgery at Aakash Healthcare Super Speciality Hospital, Dwarka, Delhi.