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What is squint or strabismus?
Squint or strabismus is a condition where both eyes do not point in the same direction. This misalignment of the eyes can result in the eyes being either convergent (looking towards the nose) or divergent (looking away from each other or wandering out) in straight gaze. This may become more evident when tired, while daydreaming, after an illness or following close work and is usually noticed at the end of the day.
It may be accompanied by double vision, headaches or blurred vision. Sometimes the squint is not noticed by the patient but by friends or relatives or picked up on in a photograph or video.
Can a squint be treated?
Contrary to popular belief, a squint can be treated at any age. Some squints can be treated with glasses (with or without prisms) or contact lenses, others with Botox and some patients need a surgical procedure for a definite cure.
People choose to have their squints corrected for different reasons with social embarrassment being the most common.
With advances in surgical skills and techniques over the last few years squint surgery is now much safer and more successful than previously.
A special technique for squint surgery is used at our centre that leaves a small scar hidden under the upper or lower lids. As the surgery is carried out through a small opening, the eyes settle down much sooner with an excellent cosmetic result. This technique has been presented at various meetings all around the world including Australia, Europe and the UK and has been published in the Journal of Paediatric Ophthalmology and Strabismus, a journal of international repute.
When should a squint be referred?
All squints should be referred as early as possible. A squint may be correctable at an early age by the use of patches or glasses. At a later stage surgery or Botox may be required. A squint may present by itself or be due to an unsuspected underlying disease and thus all squints need to be investigated thoroughly.
What to expect when undergoing squint surgery?
Squint surgery is carried out under general anaesthetic and the duration varies with the complexity of cases with most lasting less than an hour. It is carried out as a day case procedure and the patient can go home the same day. Most adults have squint surgery using adjustable stitches which can be used to ‘fine tune’ the result after the operation for the best cosmetic outcome.
The eye is red following the procedure and drops to reduce the inflammation and prevent infection are supplied after the surgery. No patches or pads are needed.
The redness wears off within three weeks. During this time swimming and heavy exercise are not advisable. Children may have to stay off school for the first week. An immediate postoperative appointment is arranged for the next day and then after three weeks.
What is Botox?
BOTOX® is a purified protein that comes from the bacterium clostridium botulinum. It works by preventing nerves from releasing acetylcholine, a substance that transmits signals from nerves to muscles.
How is Botox used in the treatment of children eye conditions?
Botox is widely used in treatment of squint or strabismus as it weakens the overacting muscles thus improving the alignment of the eyes. It can be used before surgery to demonstrate the possible effects of the operation. Some patients who are unwilling or unsuitable for surgery can gain an excellent temporary or even permanent solution with Botox.
The effects of the procedure are apparent within a few days; reach a peak around two weeks and then taper off. They usually wear off by three months but the injection can then be repeated.
Side effects and contraindications?
Botox is a safe and very well tolerated drug and there are very few serious side effects associated with its use as the quantities involved are too small to cause systemic effects. It is possible for the toxin injected to diffuse and cause drooping of the eyelid but this usually gets better within 3-4 weeks of injection.