Understanding squint: A comprehensive overview

In his latest online article, Mr Nadeem Ali gives us his insights into squint surgery.  Squint, also known as strabismus, is a medical condition impacting the eyes. In individuals with a squint, one eye does not align correctly with the other. This misalignment can manifest as the affected eye turning inward toward the nose, outward, upward, or downward. The squint may be constant or intermittent, and the individual might have partial or no control over it. Squinting can involve one eye exclusively or alternate between both. While squints are often associated with a lazy eye (amblyopia), where one eye has impaired vision since childhood, they can also occur in otherwise healthy eyes with good vision. Squints may develop in childhood or adulthood, and most cases are not caused by serious underlying medical conditions. Squinting is sometimes colloquially referred to as cross-eye, lazy eye, boss eye, or wall eye.

Effects of squint on individuals

Those living with squint are acutely aware of how it can significantly impact their lives, but many people, including medical professionals, underestimate its importance. Individuals with squint experience two primary challenges, which may occur separately or concurrently:

1. Vision problems: Squints often lead to double vision, where an individual sees two images of a single object. For instance, when looking at a road sign, they may perceive two signs, one real and another adjacent image. In some cases, objects in the peripheral vision obstruct their line of sight. Double vision can disrupt daily activities such as reading, working, participating in hobbies, playing sports, and even driving. Fortunately, surgical intervention can often alleviate double vision, allowing individuals to resume their normal routines.

2. Impact on self-confidence: Squints can significantly affect an individual's self-esteem and self-image. Those with squint frequently worry about how others perceive their eyes, whether at home, work, during social interactions, or while out in public. This self-consciousness can lead to nervousness when making eye contact, especially when meeting new people or engaging in professional presentations. Squint can also influence personal relationships, self-esteem, and overall self-image. Many individuals with squint feel embarrassed about their eye condition, which can deter them from seeking specialised treatment. However, successful treatment often leads to a remarkable boost in self-confidence.

Treatment options for squint

The treatment of squint depends on its severity and impact on an individual's life. Here are several treatment options:

Observation: In cases of mild squint that do not significantly affect daily life, a "wait and see" approach may be appropriate. Some minor squints are not noticeable to others and do not warrant intervention.

Glasses: Individuals who are farsighted may benefit from corrective glasses, which can help align their eyes.

Botulinum toxin injections (Botox): Botulinum toxin injections can temporarily improve squint by altering the position of the eye muscles. While this treatment is relatively quick and performed with local anaesthesia, its effects are not permanent, lasting about 3-4 months, necessitating repeated injections. It can be a suitable option for those who cannot undergo surgery.

Surgery: Squint surgery involves modifying the eye muscles to change the direction of the affected eye. This can include moving a muscle forward, backward, shortening it, or reattaching it at a different point. Importantly, no part of the eyeball is removed, placed elsewhere, or turned around during this surgery. Access to the eye muscles is achieved through the white membranes on the eye's surface, avoiding eyelid skin incisions. Squint surgery typically lasts under an hour and can be performed under general or local anaesthesia. The success of the surgery depends on the surgeon's skill and precision.

Goals of squint surgery

The primary objective of squint surgery is to enhance an individual's quality of life by addressing their specific needs. Surgery aims to achieve various goals tailored to the individual's situation:

Correct double vision: Surgery can reduce or eliminate double vision, allowing for a single, clear view of objects.

Improve eye alignment: Squint surgery aims to align the eyes, eliminating the need to tilt or turn the head for proper alignment.

Enhance eye coordination: The procedure can help the eyes work together more effectively, reducing strain.

Boost self-confidence: For those concerned about their appearance, squint surgery can make the eyes appear straighter and more natural, reducing self-consciousness and promoting self-assurance, especially in social and professional settings.

Risks associated with squint surgery

While squint surgery is considered one of the safest eye surgeries, there are inherent risks associated with any surgical procedure. Some common risks include:

Inaccuracy: Squint surgery may not achieve perfect alignment in every case, potentially resulting in under correction or overcorrection.

Temporary double vision: Following surgery, some individuals may experience temporary double vision as the brain adapts to the corrected eye position, which typically resolves within weeks.

Loss of vision: Although extremely rare, there is a minimal risk of vision loss associated with squint surgery.

Healing and redness: After surgery, the eye may be red and irritated, with redness typically resolving within a few weeks to months. Stitches may cause grittiness but dissolve on their own. In some cases, an exaggerated healing response may lead to a small, raised scar that requires additional treatment. When considering surgery, individuals should consult with a squint specialist who can provide detailed information about the specific risks and benefits based on their unique circumstances.

Recovery from squint surgery

Squint surgery is typically performed as outpatient surgery, allowing individuals to return home on the same day. During the initial days following surgery, patients may experience a dull ache in the eye, which can be managed with over-the-counter pain relievers such as paracetamol. The first week may involve eye irritation, grittiness, excessive tearing, stickiness, redness, and temporary blurriness. Swelling of the eyelids may also occur, making the eye appear smaller. These symptoms are part of the normal healing process. 

Over the subsequent 5-6 weeks, these symptoms gradually improve, with grittiness attributed to dissolving stitches. Rubbing the eye should be avoided, as it can disrupt delicate stitches. Eyelids can be cleaned with wet kitchen roll. if they become crusty or sticky, but direct contact with the eye should be avoided. Most individuals can return to work within 1-2 weeks, though driving may be resumed after a week or two once double vision is resolved.

Prescribed eye drops, typically including an antibiotic (chloramphenicol) and a steroid (dexamethasone), are used for about 7 weeks post-surgery to aid in the healing process. Regular follow-up appointments with the surgeon are necessary to monitor healing and the final eye position.

Mr Nadeem Ali is a distinguished ophthalmologist with over 20 years of experience. You can schedule an appointment with Mr Ali on his Top Doctors profile.