what is a squint

A squint or strabismus is a medical eye condition where both eyes don't point in the same direction. This can be present from birth or occur as people get older. It can happen occasionally, for example when tired, or it can be there all the time. It may be only one eye that is affected or swap between each eye. It may only be present when you look in a particular direction, for example upwards. You may or may not get double vision if you have a squint.

In most cases of squint there is no underlying cause but occasionally it can be linked to a medical condition and further investigation and treatment may be needed.

how does having a squint affect you

For some people squint can cause visual symptoms; this can be double vision where instead of seeing one image of an object you see two images. This can be very debilitating, causing difficulty doing normal tasks, being unable to drive, struggling with work, their hobbies and sports. Others may just feel they are straining their eyes and tasks, such as reading, can feel uncomfortable as their brain tries to keep both eyes working together.

Others find that they hold their head in a certain position to help control their eyes, for example, tilting to one side. This can have happened for some time and may be noticed looking back at photos. They may complain of neck and back pain as a result. 

​Squint often causes problems with self- esteem. If you have a  squint you may feel self-conscious, concerned that others may notice your eyes are not aligned. Squint can affect your self-image, and cause anxiety particularly in social situations, for example meeting people for the first time or giving presentations. The impact of a squint on your confidence, can affect your personal relationships and your career.

Can a squint be treated

​Fortunately Yes! Although many people affected by squint are often too shy to seek advice; we actually  can help most people improve their symptoms and eye alignment, regaining normal function and self-confidence.

​Age is not a barrier to treatment either and we are happy to assess anyone who has a squint to see how we can help.

what happens at your first appointment

You are first seen by an orthoptist who will take a full history of your eye condition including details of any past treatments or surgery you may have had. They will will ask about your general health and any medications you take. 

They will then measure your vision and assess your eye movements. Please bring any glasses or contact lenses you usually wear.

You will then be seen by Stephanie who will examine the structure of your eyes. She will then explain the diagnosis and treatment options with you.

Orthoptists are experts in measuring vision, eye movements and how your eyes work together.

We work closely as a team to make the diagnosis and the best management plan for your eyes. 

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what are the treatment options

Treatment options depend on your symptoms, and the type of squint that you have.

For some people glasses (or contact lenses) alone can improve the appearance. Using a prism can help alleviate symptoms of double vision.

Botulinum Toxin (Botox) is also commonly used to treat squints. Ophthalmologists have used botulinum toxin from long before it was used for cosmetic purposes. This can be used and treatment repeated to improve the eye alignment. It is done under local anaesthetic, so is suitable for people who don't want  to have a general anaesthetic or whose eyes are not suitable for further squint surgery.

Squint surgery provides the most long term benefit. The eye muscles are either 'strengthened' or 'weakened' depending on the type of correction required and the procedure is undertaken under general anaesthesia.

One of the common question we are asked is if exercises can improve squints. Whilst exercises generally don't do any harm there is very little medical evidence to suggest they help squints long term. There are a couple of exceptions when we might recommend exercises but for most people they would make very little difference.
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types of squint

There are many different types of squint, here are some of the different medical terms we use describe them:

• ​Esotropia - the affected eye is turning inwards
• Accommodative Esotropia - this is when the inward turn may be due to the eye trying to focus, wearing glasses or contact lenses can help control it.
• Exotropia - The affected eye is turning outwards
• Intermittent exotropia - this is when the eye drifts outwards some of the time
• Convergence insufficiency - when your eyes are unable to come in close enough together when looking at a close up object
• Hypertropia - the affected eye is pointing upwards
• Hypotropia - the affected eye is pointing downwards
• Dissociated Vertical Deviation (DVD) - when the affected eye drifts upwards
• Brown's syndrome - an eye condition you can be born with where the eye cant look up and inwards
• Duane's syndrome - an eye condition you are born with that affects the way eye move horizontally
• Fourth nerve palsy - a problem with one of the nerves controlling an eye muscle often causing the affected eye to move up
• Sixth nerve palsy - a problem with one of the nerves causing the affected eye not to be able to move outwards
• Third nerve palsy - a problem with one of the nerves which can affect several eye muscles including the eyelid

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