Looking squint straight in the eye

Strabismus, colloquially known as squint, is a condition where the eyes are misaligned – for example, when supposedly looking straight ahead, one eye may be fixed to the correct point, but the other could be turning inward, upward, downward, or outward. This disorder can be present in one eye or both and can be a constant or intermittent issue. It differs from the verb to squint (where a person might narrow their eyes in an attempt to get a better look at something up close or far away) and also from a lazy eye (amblyopia). Strabismus has several possible causes; it can develop later in life, but it is possible to be born with this condition, which is called congenital strabismus. Mrs Sarah Maling, a leading consultant in the field of ophthalmology, breaks down the details of strabismus and how to see the signs of it in children.

What causes strabismus in children?

For those born strabismus, it could be due to one of a multitude of factors. It could be due to genetics, a weakness of the eye muscles, or a neurological issue that developed even before birth. Babies who develop strabismus in their first year of life are categorised as having infantile esotropia. This can develop as early as three months of age, and affects nearly one in  30 children in the UK.

Children with squint don’t tend to suffer from double vision and the subsequent headaches or disorientation as they are used to their eyes functioning in this way. For older children and adults who later develop the condition, their visual capabilities are much more hindered. It is possible for it to go away on its own, especially for children with intermittent squint. At that stage of their lives, their brains and eyes are changing every day and as their visual capabilities are coming in, their brain is constantly configuring how to use the eyes as a pair – however, it can also mean that it takes long to notice that your child has something wrong with their eyes. Those with constant squint are unlikely to grow out of the condition. In either case, it is always recommended to get clinically assessed by an ophthalmologist. The eyes are a delicate system and issues with the eyes may be linked to an unknown neurological condition.

Regardless of the cause, if unaddressed in babies and infants when first noted, it can become a lifelong issue. If the muscles of the errant eye aren’t corrected early enough, then they become too weak and affect the vision. This is atrophy is called a lazy eye and can only be addressed with surgery. Aside from the sensory and coordination issues this may cause the child, it can impact their self-confidence and social engagement, especially as they get older and begin their schooling.

What are the signs of strabismus in children?

Aside from the misalignment of the eyes, here are other symptoms of the conditions:

-          tilting the head to the side when looking or staring at things

-          closing or favouring one eye to focus

-          descriptions or complaints of double vision (in older children)

If your family has a genetic history of long-sightedness (hypermetropia), then keep an eye out for the above symptoms – babies and children born with long-sightedness can easily develop strabismus as a way to accommodate their vision and bring their focus closer.

What are the treatments for strabismus?

Fortunately, if caught early enough in your babies and infants, squint can be treated through therapeutic means. This is because, as children’s bodies are still growing and changing, their muscles and brains are incredibly plastic and can be “taught” to function properly. Methods may involve wearing corrective eyeglasses or an eye patch to strengthen the weaker eye, or daily vision exercises. However. for older children and adults, options are reduced as musculature becomes more fixed, and medical intervention may be required. This can take the form of an ocular surgery to reconfigure the muscles of the eye and straighten its position, or even shots of Botox (Botulinum Toxin, which was originally invented for this purpose!) to the eye.

If you are concerned about your child exhibiting signs of strabismus, Mrs Maling is available for consultation which can be booked via her Top Doctors profile.