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Paediatric Opthalmology & Squint Treatment

Childhood eye problems are common. Eyes that ‘wander’, vision problems, eye infections, and eye injuries are all common among children. You can help protect your child’s eyesight by watching out for warning signs and taking your child to a doctor at the first sign of a problem.

Watch for:

  • Eyes that cross or one eye that turns in or out or up or down
  • One eye that seems different in some ways such as a larger or smaller pupil
  • Eyes that look crusty, swollen, bloodshot or red-rimmed
  • Any discharge, bleeding or red bumps on the eyelids
  • A pupil that shows a white rather than a red reflection in a colour photograph

Child Behaviour

  • Closing one eye or turning or tilting to see things.
  • Squinting to see things in the distance.
  • Consistently holding objects close to the face or sitting very close to the TV (most Children do this sometimes)
  • Frequently blinking or rubbing one eye.
  • Running into objects or falling down at night or in places that are dimly lit.

Child Says

  • Not able to see the chalkboard at school
  • Objects looking blurry or funny
  • Getting hit in the eye or object entering the eye
  • One or both eyes hurting or pain inside or around one or both eyes
  • Eyes hurting while looking at the light

What is Wandering Eye ?

Sometimes a child’s eyes do not work together as they should. One eye may be ‘lazy’, or wander in or out, or up or down (strabismus). In such a case, the brain receives a different image from each eye. The brain may switch back and forth between the two images, or it may turn off the weaker image.

What is Squint (strabismus)?

Very simply put, squint is an eye condition wherein both the eyes point in different directions. While one eye focuses on a particular object, the other eye focuses away from it—either downwards or upwards. Sometimes it may even focus away and come back, and sometimes it keeps moving back & forth between the object and the surroundings. Such misalignment of the eyes is referred to as squint or strabismus.

Vision problems

Sometimes a child cannot see objects that are far away (near-sightedness) or objects that are close up (far-sightedness). A child can even be so far-sighted that both near and distant objects are blurred.

If the front of the child’s eye (cornea) is irregularly curved (astigmatism), objects look blurry at all distances. However, these common childhood vision problems can almost always be corrected with glasses or contact lenses. In some cases, vision problems can lead to amblyopia if not corrected.

Nonsurgical management of squint

Optical management involves :

  • To check refraction and prescribing correct spectacle power . this is to be checked at regular intervals
  • Eye exercises which your ophthalmologist may suggest
  • Treatment for amblyopia may be suggested.

Surgical management of squint:

If other treatments are unsuccessful, surgery may be needed to correct a squint.

Surgery can be used to:

  • improve the alignment of the eyes (and therefore their appearance)
  • help the eyes work together

Surgery involves moving the muscles attached to the outside of the eye to a new position. It may be necessary to operate on both eyes to balance them, even if the squint is only in one eye.

There are six different muscles attached to each eyeball and they tend to work in pairs. During the Strabismus operation it is normal that for a pair of muscles one is weakened and the other strengthened to make the eye straighter. It may be necessary to operate on both eyes to balance them, even if the squint is only in one eye.

In some cases adjustable sutures will be used, so that shortly after the operation any minor adjustments can be made to achieve the best possible position of the eye.

If a muscle is too strong when you have strabismus, it may cause the eye to turn in, turn out or rotate too high or low.

On the other hand, an eye muscle weakness in certain cases may also cause misalignment. This condition may occur if you have a cranial nerve dysfunction affecting how eye muscles control movement.

Strabismus Surgery Involving Recession and Resection Procedures

In a recession procedure, your eye surgeon detaches the affected outside muscle (extraocular muscle) from the eye and reattaches it (resection) farther back on the eye to weaken the relative strength of the muscle if it is too strong.

In contrast, if the muscle is too weak, your surgeon may use a recession procedure to reduce strength of the opposing muscle (antagonist) to achieve more balanced function of the eye muscles.

In certain cases, a resection procedure may be used to strengthen an eye muscle to correct misalignment associated with strabismus. If you have inwardly turned eyes (esotropia), the surgeon may strengthen the lateral rectus muscles — located on the side of each eye, toward the ear — by reattaching the muscle in a different location (resection). In this way, the lateral rectus muscles are relatively strengthened and they can turn the eyes farther outward. This results in better eye alignment.

Adjustable Suture Strabismus Surgery

With adjustable suture eye muscle surgery, your surgeon adjusts sutures holding eye muscles in place after a resection procedure, to attempt to improve your final outcome.

This surgery is probably best for someone in whom strabismus developed in adulthood after previously normal eye alignment.

Adjustable suture surgery is performed in the operating room, with general or local anesthesia. Afterward the eye is patched. About four to 24 hours later, the patch is removed in the office, when anesthesia and sedation have faded. Ocular alignment is then evaluated.

Based on how your eyes are aligned, your surgeon may decide to use the suture that is in place to tighten or loosen the treated muscle. This adjustment may cause slight discomfort, primarily with muscle tightening.

Once the desired alignment is achieved, the surgeon ties the adjustable suture permanently in place, and the procedure is complete.

Services available at Ojas

  • Convergence and accommodation anomalies management
  • Squint Surgery including complicated strabismus
  • Amblyopia Therapy
  • Synaptophore exercises
  • Examination under anaesthesia
  • Probing and Syringing
  • Paediatric Cataract
  • ROP Laser

A Center of Excellence for Ojas Eye Hospital