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What is a Strabismus?

Strabismus, or squint eyes, refers to a condition of misalignment of the eyes. The misalignment can be horizontal, vertical or obliquely oriented. The main types are:
Inward squint (Esotropia)
Outwards squint (Exotropia)
Upwards/Downwards squint (Hypertropia/Hypotropia)

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Role of Pediatric ophthalmologists.

Pediatric ophthalmologists treat all eye problems in children under the age of 15 years. As strabismus is one of the common problems in children, pediatric ophthalmologists are trained to treat strabismus in children and adults. A child should not be regarded as a small adult. Children have unique needs and concerns. An incorrect treatment decision or a delayed treatment could result in a permanent impairment of vision. Children do not volunteer complaints, and may not give a reliable history. Many a time they would not cooperate for an exam either. There are special techniques to assess vision in children. Special hand held instruments are needed to examine very young children. A child friendly atmosphere is also required in the examination area to win the confidence of children.

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What are the symptoms associated with a squint?

Children and adults adapt differently to squints and therefore experience squints differently. Young children will usually have no complaints but ill have the temporary/persistent squint noted by the parents. This squinting may also be masked by one eye "winking" when exposed to excessive sunlight. In this age group, prompt intervention is required to prevent 'lazy eye'(amblyopia) from setting in. Adults with a new squint will complain of double-vision(diplopia) and may adapt by closing one of the eyes to avoid seeing multiple images.

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What are the causes of a squint?

Squints are broadly either due to an eye muscle weakness, an eye focusing weakness or a combination of the 2. Primary squints (Infantile squints and Accommodative) develop early and are different from the Secondary squints seen in adults that develop from vascular problems(Diabetes,Hypertension etc) & other neuro-ophthalmic diseases.

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When should the squint be treated?

In a child, the treatment of squint and any associated amblyopia should be started as soon as possible. Generally speaking, the younger the age at which amblyopia is treated; the better is the chance of recovery of vision. Remember that the child would never grow out of squint. A delay in treatment may decrease the chances of getting a good alignment and the vision.

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What is the treatment for squint?

The aims of treatment of squint in order of importance are:
Preserve or restore vision
Straighten the eyes
Restore binocular vision
First of all, the eyes are checked to see if they have any refractive error that may be responsible for squint. If there is any significant refractive error present, it is treated first. In some cases (accommodative squint) a correction of refractive error is all that may be required to treat squint. Next the eyes are checked for presence of amblyopia. It is important to treat the amblyopia before the surgery for squint. The parents are explained about the importance of this treatment, as their cooperation is very crucial for the success of this treatment.

The squint is treated by surgery of either one or both the eyes. The surgery involves weakening or strengthening of the relevant muscles to restore the balance and to get a good coordination. In some cases with double vision, prisms may be added in the glasses to ease the symptoms.

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