05 Apr

Squint – Part II

From the Desk of President All India Ophthalmological Society, India
by Dr. Quresh B. Maskati, President A.I.O.S.

Q. What are intermittent squints? How are they managed?
A. As the name suggests, these squints are not constant. They may be seen or manifest, only when the child is daydreaming or unwell or exhausted or emotionally upset. These squints are usually kept under observation. They may either resolve spontaneously, thus requiring no treatment or become constant requiring treatment.

Q. Is there any role for medical management of squint? Any eye drops or Vitamin pills?
A. There is absolutely no role for medical management of any manifest squint, except those due to endocrine or neurological disorders. Some intermittent squints and some traumatic squints may resolve spontaneously over time.

Q. At what age should squint surgery be advised?
A. In divergent squints, it should be done when detected, as waiting does not help. In convergent squints of the non-accommodative type (no significant refractive error), again, the earlier operated the better.
In convergent squint due to accommodation, corrective glasses are first prescribed. If amblyopia exists it is treated as mentioned earlier. If the squint shows signs of improvement by these methods, surgery is delayed till no further improvement occurs. The remaining or residual squint is then surgically corrected.

Q. Do squints cause psychological problems?
A. Yes.  Children with obvious squints are often teased by their peers in nursery and school. They then become shy, withdrawn, introverted. Even if bright, they refuse to volunteer to answer questions in class and consequently often do badly at studies. They end up with an inferiority complex and may even become social misfits.

Q. Is squint surgery ‘safe’?
A. Yes. Modern anaesthesia ensures that squint surgery can be safely done even in newborns.  There is no danger to vision, as the surgery is an extra-ocular one and the eyeball is not opened.  Hence there is virtually no risk of blindness following squint surgery It is usually performed as a day care surgery, even if under general anaesthesia. The bandage on the operated eye is usually removed after 24 hours. No special post-operative precautions or care is required. Stitches are usually required, which dissolve on their own leaving no scar. The child can resume school in a week, though he may have to continue drops for one month or more.

Q. Can squint be operated at a later age?
A. Yes. Squints can be operated at any age for cosmetic reasons and the eyes can usually be made perfectly straight. In fact, many ignorant parents bring their unmarried daughters with squint for correction before she enters the “marriage market” as the dowry she has to pay goes up manifold if she has a squint! However, if the surgery is done after the child is 5 or 6 years old, the squinting eye is already lazy. Hence, though the eyes are made straight by surgery, vision in the lazy eye cannot be restored. Therefore, ideally, squints should be referred to an eye surgeon as soon as they are detected.

Q. Can squint be a marker for a serious eye disease?
A. Yes. An eye blind from birth or blinded later in early childhood, due to unilateral cataract or eye tumour such as retinoblastoma or severe trauma can also develop squint. An eye surgeon will always rule out these diseases before he proceeds further with squint management.

Q. Can paralytic squints be corrected surgically?
A. Yes. Paralytic squints either resulting from birth trauma, such as forceps delivery causing 6th nerve or lateral rectus muscle paralysis or due to vehicular or other trauma in adulthood can be successfully surgically corrected using muscle Tran positioning techniques.

Q. Your chapter was too long. Is there a single “take home” message you have for people like me who refuse to read the whole article?
A. Yes. Please note that almost all squints can be corrected surgically for cosmetic purpose at any age. Best visual results come from those patients corrected in early childhood before the age of 5 years. Do advise those near and dear to you who have a patient with squint in the family to take them to an eye surgeon as early as possible for opinion- in case the squint is due to retinoblastoma, you may even save a life!

Q. Can people with squint, operated or unoperated donate their eyes after death?

A. Yes, they most certainly can. For useful eye donation, all you need is a clear cornea, which almost all squint patients possess. Do read the chapter on Eye Donation for further details.

Squint – Part I

Dr. Quresh B. Maskati,

President (2014-2015) at All India Ophthalmological Society
Gold medallist in DOMS. Passed MS (ophth) in 1983 at 1st attempt. Super specialised in diseases of cornea and anterior segment in Rochester and Boston, USA. Is the only ophthalmologist in the world with extensive experience in both the Pintucci and the Boston Keratoprosthesis.
Goal: Long term:to help eradicate corneal blindess from the world.
Short term: To publish a my book "Simplifying Eye Care" in Hindi and other Indian languages for patients. The English edition is already under reprint.

Specialties:Squint, paediatric ophthalmology, cornea and ocular surface disorders, keratoprosthesis surgery and research, oculoplasty and LASIK