Paediatric Opthalmology & Squint Treatment

Symptoms tend to affect both eyes, and can include:

• 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

• 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

Observe what your 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.

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.

Types of Squint

• Squints are classified depending on direction of the squinting eye
• Convergent squint or esotropia when one eye is turning in
• Divergent squint or exotropia when the eye is turning out
• Vertical squint (Hypertropia / Hypotropia) when one eye is pointing upwards/downward

CAUSES

The precise cause of squint is unclear in a large proportion of childhood squints. It is understood that the condition may be due to mis-functioning of the brain in moving the eye muscles synchronously. There is no defect in the eye muscles themselves. The other causes leading to a squint can be refractive errors like hypermetropia (long-sightedness), myopia (short-sightedness), astigmatism or unequal refractive error in both eyes.

TRAUMA:

Brain trauma and certain brain tumours may also cause the eye to turn in. If a child develops a sudden in-turning of the eye associated with nystagmus (involuntary eye movements), an urgent assessment is required as it suggests a build-up of intracranial pressure or a possible tumour.

Abnormality of the eye muscles or in their nerve supply as in

• Myasthenia gravis.
• Sixth Cranial Nerve Palsy (in children, this occurs frequently post a viral infection and may cause sudden onset of esotropia).
• Trauma to the eye.
• Duane's Syndrome.
• Strabismus Fixus.
• In adults Usually an untreated childhood squint.
• Following previous Squint surgery.
• Decompensating squint, previously under control but now getting worse.
• Paralytic squint - sudden onset in patients with underlying hypertension or diabetes.
• Thyroid Eye Disease, due to inflammation/swelling caused by scarring of the eye muscle. Once the inflammation has subsided, surgery is advised if symptoms of double vision are present.
• Trauma to eye muscles e.g., as a complication of sinus surgery.

EARLY DIAGNOSIS

If the proper visual impulses are not transmitted to the brain in the first few months after birth, which is the critical period of visual development, amblyopia will develop and there will be loss of 3D (binocular) vision.

Prisms

These are specialised glasses used to treat double vision of sudden onset. They can be used as a temporary measure and are later incorporated into the usual spectacles. They can also improve the appearance of a squint in some patients where surgery is not an option.

Non-surgical treatment

These are specialised glasses used to treat double vision of sudden onset. They can be used as a temporary measure and are later incorporated into the usual spectacles. They can also improve the appearance of a squint in some patients where surgery is not an option.

Treatment done by Prisms

BOTOX

In adults and occasionally in children, Botulinum toxin may be the first line of treatment. The toxin is injected into the muscle at the surface of the eye. It temporarily paralyses the muscle in the direction of the squint and balances the forces producing the misalignment. It causes an overcorrection initially and the eye may move in the direction opposite to the squint in the first few weeks. The eye will gradually straighten and then return to its original position. Repeat injections are usually required to maintain the corrected position of the eye.

SURGICAL OPTION

To achieve surgical correction, the eye muscles in one or both eyes (depending on the degree and direction of the squint), are tightened or loosened. The muscles are shortened and reattached to the eye to tighten or moved further back which has the effect of loosening. If the eye is turning in (convergent squint), the muscle which pulls the eye in (the medial rectus) is moved back and the outer muscle (the lateral rectus) is tightened to straighten the eye. The amount of surgery is based on normograms that are tables which have been developed based on results of muscle surgery in thousands of patients.

WHY YOU CAN CHOOSE SQUINT TREATMENT WITH US?

Envision Eye Hospital is well-equipped with the state-of-the-art facilities for examining and treating children eye related disorders. The most common childhood eye diseases treated are Refractive Errors, Squint, Amblyopia, Childhood Cataract, Genetic Eye Diseases and Congenital Glaucoma.We also involve in screening and offers treatment for Retinopathy of Prematurity (ROP). In collaboration with the Vision Rehabilitation Centre, the clinic makes all efforts to enhance the residual vision in children with visual impairment by providing either optical or non-optical Low Vision Aids (LVA). Children suspected/ found with disorders related to Cornea, Retina, Uvea, Orbit & Glaucoma are treated at this centre.

Routinely performed procedures include

• Surgical correction of Cataract as early as 3 months of age under General Anaesthesia (GA)
• Surgical correction of all types of Strabismus under Anaesthesia appropriate for age (General/ Local)
• Examination under Anaesthesia: For children who need detailed evaluation (where cooperation is a concern) and for whom various specialty opinions are required at the same time.
• Electroretinography (ERG) under short GA in retinal dystrophies
• Surgery for Nystagmus
• Advanced treatment for Squint, Double Vision, Amblyopia or Lazy Eye, etc.
• Refraction in young children
• General eye problems such as Eye Sore and Lump on the Eyelids, etc.
• Glass vision and low vision aids
• Allergic eye conditions and other eye infections
• Complete surgical care for Paediatric eye conditions
• Synaptophore exercises
• Examination under anaesthesia
• Probing and Syringing
• Paediatric Cataract
• ROP Laser