Squint and Squint Surgery
What is a squint?
A squint is when one eye does not point in the right direction – whilst the unaffected eye looks straight ahead, the eye with the squint may look inwards towards the nose, outwards, upwards or downwards. It can be present all the time, or it can come and go and some people can control their squint whilst others can’t.
Squints often occur in a lazy eye, which has had poor vision since childhood, but they can also occur in eyes with good vision. In addition, it is possible for a squint to develop in adulthood. Whilst most squints aren’t serious, some are caused by a more serious medical condition.
In casual conversation, you may have heard a squint also referred to as cross-eye, boss-eye, lazy eye etc. but there are technical terms for each type of squint:
Exotropia – an outward turn of an eye
Intermittent Exotropia – an outward turn that is only there some of the time
Exophoric – an outward drift that is mostly controlled by the brain
Esotropia – an inward turn in the eye
Intermittent Esotropia – an inward turn that is only there some of the time
Esophoria – an inward drift that is mostly controlled by the brain
Accommodative Esotropia – an inward turn of the eye that glasses may help
Convergence Weakness – a problem of bringing both eyes together for reading up close
Convergence Spasm – a problem relaxing the eyes which often gives eye strain
Hypertropia – where one eye is higher than the other
Hypotropia – when one eye is lower than the other
Duane’s Syndrome – a problem from birth with horizontal eye movements
Brown’s Syndrome – a problem from birth with looking up and inwards
Sixth Nerve Palsy – a problem with one of the nerves from the brain to the eye Fourth Nerve Palsy – a problem with one of the nerves from the brain to the eye
Are you affected by a squint?
If you have a squint, you know how much it can affect your quality of life and more importantly, your vision.
There are two main ways that squints affect sufferers:
- Vision
A squint usually means that someone sees double, for example seeing two versions of one object – the real one and another one next to it. This can cause many issues in daily life, often meaning that you are unable to drive and other activities such as sports, hobbies and reading are affected. - Self-Confidence
Having a squint can really affect your self-confidence, especially worrying about how you look to other people. You may avoid making eye contact, or lack confidence meeting new people. This embarrassment can also stop many sufferers from seeking the help of a specialist.
Can a squint be treated?
For most people, yes! There are a number of options available.
If you have a very minor squint that doesn’t really affect your daily life, it may be best to leave it alone. However, if you’re thinking about squint treatment then it probably is significant enough to consider treatment.
Some of the treatment options include:
Glasses – A squint can be helped with just glasses, usually for people who are long-sighted. The glasses help to relax the eyes, allowing the squint to correct itself.
Prism correction – A squint causes the light to fall in a different place in each eye, so prism correction in glasses is used to bend the light so that it falls in the same place in both eyes. The brain should then work to combine both images together to make one clear image.
Botox – Long before Botulinum Toxin (Botox) was used for cosmetic procedures, it was used to correct squints. Injecting Botox into one of the eye muscles can change the position of the eye and improve the squint. This is not a permanent solution and requires injections every 3-4 months but is suitable for people who cannot undergo surgery.
Can eye exercises cure a squint?
Some doctors claim this is possible, but there is very little evidence that eye exercises succeed in treating a squint long-term. There are some exceptions, and there’s no harm in trying, but most people find that eye exercises don’t really improve a squint.
Can my squint be treated?
Every case is different, but generally, if you can satisfy the following then you are a good candidate for squint surgery:
- Your squint affects daily life
- Your squint is noticeable
- Your eye tissues are healthy enough for surgery
Previous surgery is not a bar to squint surgery and neither is age. You can have squint surgery at any time in adult life. I can also work with most other medical issues and will carefully plan your surgery with the anesthetist and any other required specialists. I refuse very few people on medical grounds.
The choice to go ahead with surgery is entirely yours. During consultation, I will provide you with all the required information and answer any and all questions that you might have.
Squint Surgery Procedure
Your eyes move through the use of 6 muscles on each eye. Two muscles move the eyes horizontally, two vertically and the other two, known as the obliques, carry out a combination of other movements.
During squint surgery, one or more of these muscles are altered to cause a change in the eye’s direction. A muscle can be moved forwards, backwards, shortened or moved to a different attachment point. It is then stitched into place and will reattach itself and heal within a few weeks.
If you think that the eyeball is taken out of the socket, or turned around in any way, it is not! These are just old stories that are not true. The muscles are accessed via the transparent membrane on the surface of the eye and all surgery is carried out outside of the eyeball. Also, no lasers are used as they might be in other eye surgeries.
Most squint surgeries are completed within an hour. Whilst most people opt for general anesthetic, the procedure can be carried out under local anesthetic. If you choose local aesthetic, you’ll be given a sedative to help relax. Successful squint surgery is really down to the skill and experience of the Surgeon knowing the problem and exactly how to rectify it. I have been carrying out squint surgeries for over 30 years and have an extremely high success rate. I will ensure that you are kept informed of the whole procedure and make your aftercare as comfortable as possible.
After Surgery and Ongoing Care
You should be able to go home the same day of your surgery and may have a patch over your eye for a short time.
Your eye will be sore for a few days and you will be given painkillers and eyedrops to aid healing.
There are a few other side effects that you may also experience:
- Eye pain – this feels like ‘grit’ in your eye and can be eased with painkillers. It should last no more than a few days.
- Red eyes – this can last up to two months and you may also experience bloody tears for a day or two
- Itchy eyes – This is caused by the stitches and will last until they dissolve (a few weeks). Try not to rub your eyes to relieve this
You will have follow-up appointments with me after surgery, but please get in contact with me or your GP if you have any severe or longer-lasting side effects.
When will I be back to normal after surgery?
It usually takes several weeks to fully recover from squint surgery.
It will depend on your individual circumstances, but you should be able to return to the following activities as follows:
- Reading, Watching TV – as soon as you feel able
- General daily activities – as soon as you feel able
- Driving – wait at least 2-3 days, or until double vision has resolved
- Exercise and Sport – Wait at least a week, maybe more for swimming or contact sports. We will discuss this during your consultation
Things not to do:
- Don’t wear make-up close to your eyes for 4 weeks
- Don’t allow a child to play in sand or use face paint for 2 weeks
- Try not to get any soap or shampoo in the eye when showering
- Don’t wear contact lenses until advised (glasses are fine)
What are the risks of squint surgery?
This is actually one of the safest eye surgeries, because it doesn’t involve penetrating the eyeball. There are however, still some risks which I will discuss with you individually.
Generally though, the commonest risk is that squint surgery is not 100% accurate in all cases. There is risk of under-correction or over-correction, meaning that not enough correction is done and the squint is still there, or too much is carried out and the eye goes in the other direction. Both of these problems can be rectified with additional surgery if necessary. The risk of additional surgery is 10-15% so very unlikely in most cases.
Some patients also experience double vision after squint surgery. This is usually a signal that the brain realizes the eye has moved and needs to learn this new position and readjust accordingly. This should settle within a few weeks and require no further treatment.
There is also the possibility of infection, abscess or a cyst developing after surgery, but these can all be treated with antibiotics or a procedure to drain the fluid.
It is extremely rare to lose vision entirely after squint surgery and this occurs in only 1 in 5,000 cases.
Before your surgery, we will discuss your individual circumstances and I will ensure that you are fully aware of the risks and know the signs to look out for, should there be a problem. If you have any concerns, you can contact myself or your GP for further advice and reassurance.