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"Dr. YAP"
Eye Hospital

Sub Specialty Services / Strabismus



Strabismus or Squint

Strabismus or crossed eyes is a condition in which the two eyes appear not in the same direction or look at two different points. Under normal circumstances, our two eyes work together in looking at an object. The brain will combine the two images seen by the two eyes into a three-dimensional image that gives the perception of distance, size and depth (Depth Perception).

There are several types of Strabismus that we can observe directly by asking the patient to look straight ahead. When one eye looks straight ahead, the other eye may look inward (Esotropia), outward (Exotropia), downward (Hypotropia) or upward (Hypertropia). This occurs in about 2% of both boys and girls.

Why is Squint a Problem?

When the two eyes look not in the same direction, there will be two images sent to the brain. In adults this causes double vision. In young children, the brain learns to ignore the image from the eyes that are not the same way and just see with the normal eye. The child then loses the perception of distance, size and depth. Infants with strabismus who are six months or older should be taken to a pediatric ophthalmologist to avoid the risk of amblyopia (decreased vision function in one or both eyes). Why is Squint a Problem?

Causes of Strabismus

Strabismus can be caused by an imbalance in the pull of the muscles that control eye movement, muscle paralysis, neurological disorders or uncorrected refractive errors. Children born to families with a family history of strabismus are also at high risk of suffering from strabismus. A pediatric ophthalmologist can determine the nature of the strabismus and can recommend the best treatment.

How to Recognize Strabismus?

A clear sign of strabismus is one eye that is not straight or does not appear to be looking in the same direction as the other eye. Sometimes children will squint/close one eye in bright sunlight or tilt their head so they can use both eyes at once. Children who have strabismus from birth or shortly thereafter complain less of double vision. But children who complain of double vision should be examined by a pediatric ophthalmologist carefully. All children should be examined by a pediatric ophthalmologist from an early age, especially if someone in their family suffers from strabismus or amblyopia. Babies and young children are often seen cross-eyed. This can be caused by the shape of the nose which is wide and flat with wide eyelid skin folds that make the eyes look like they are not in the same direction. Symptoms of pseudostrabismus will disappear as the child gets older. A pediatric ophthalmologist can tell the difference between true and false strabismus.

Treatment of Strabismus

Strabismus treatment is intended to protect vision function and straighten the eyes. All of these treatments can be determined by an ophthalmologist after examining the child's eyes, which can be in the form of:

1. Glasses

If strabismus is caused by a refractive error, using glasses to normalize vision can improve eye position.

2. Blindfold

JIf a child has Strabismus with Amblyopia, the doctor will recommend training the weak eye by covering the normal eye with a special eye patch (Eye Patch). The use of eye patches should be done as early as possible and follow the doctor's instructions. After the age of 8 years is usually considered too late because the best vision develops before the age of 8 years. Your child will need regular visits to the ophthalmologist to check if his binocular vision is fully developed. Eye patches do not cosmetically straighten the eyes.

3. Operation

Surgery on the muscles that control eye movement is often done to make the eyes look straight. Sometimes before surgery, children are given glasses or blindfolds to get the best vision. Your child will need a visit to an ophthalmologist after surgery to check progress and continue treatment. Sometimes to get more perfect results it takes more than one operation.