Squint (Strabismus)
Misalignment of the eyes where both eyes do not look in the same direction - affecting vision, depth perception and confidence.
Overview & Clinical Approach
A condition where the eyes are misaligned and do not point in the same direction, leading to cosmetic and visual problems.
A squint, medically known as strabismus, occurs when both eyes do not look at the same object at the same time. While one eye is looking straight, the other may turn inwards, outwards, upwards or downwards.
Squint can be present from birth or develop later in life due to eye injury, nerve problems or other illnesses. It may be constant (always visible) or intermittent (seen only at times, usually when tired).
Squint usually occurs due to an imbalance in the eye muscles or their nerve control. When some muscles are weaker or not working in sync, one eye looks straight while the other turns in a different direction, and the brain starts ignoring the image from the weaker eye.
Apart from cosmetic concerns and social embarrassment, untreated squint can lead to reduced vision in one eye (amblyopia) and loss of 3D (binocular) vision.
In the first few months of life, a baby learns to focus, move the eyes accurately and use them together. If proper visual impulses are not received during this critical period, amblyopia (lazy eye) and loss of binocular vision can occur.
Squints are classified based on the direction in which the eye turns: Esotropia (eye turns inwards towards the nose), Exotropia (eye turns outwards), Hypertropia (eye turns upwards), and Hypotropia (eye turns downwards).
Common Symptoms
- Eyes looking in different directions at the same time
- Eyes that do not move together
- Squinting or closing one eye, especially in bright sunlight
- Poor side (peripheral) vision
- Poor depth perception (difficulty judging distances)
- Sometimes double vision (mainly in adults with recent squint)
Primary Causes & Risk Factors
- Refractive errors such as hyperopia (long-sightedness), myopia and astigmatism
- Unequal refractive error (difference in power) between the two eyes
- Brain trauma or neurological causes
- Myasthenia gravis or Sixth Cranial Nerve palsy in children (sudden esotropia)
- Trauma to the eye
- Duane’s Syndrome, Strabismus Fixus
- Previous squint surgery with decompensation
- Paralytic squint due to hypertension or diabetes
- Thyroid Eye Disease and post-sinus surgery complications
Diagnostic Procedures
- Detailed eye examination to assess the direction and degree of eye deviation
- Assessment for underlying refractive errors and binocular vision
- Evaluation for associated conditions such as amblyopia, nerve palsies, or systemic disease
Treatment Steps
Glasses
Correct underlying refractive errors and may straighten the eyes in some children.
Eye Patching
Covering the stronger eye to force the weaker eye to work, improving vision in amblyopia.
Eye Exercises & Prisms
Pencil push-ups, barrel cards, or prism lenses to improve coordination or manage double vision.
Botox / Squint Surgery
Botulinum toxin to weaken overacting muscles, or surgery to tighten/loosen eye muscles and realign the eyes when non-surgical options are insufficient. Surgical planning is based on nomograms - tables developed from the results of thousands of squint surgeries.
Risk Factors for Developing Squint
- Family history: Squint in parents or siblings
- Refractive error: Significant hyperopia (far-sightedness) increases strain on the eyes, causing them to turn inwards to focus
- Medical conditions: Stroke, Down Syndrome, Cerebral Palsy and other neurological disorders can increase squint risk
Key Treatment Benefits
- Prevents lazy eye (amblyopia) and restores binocular/3D vision
- Cosmetic & functional eye alignment tailored to children and adults
- Boosts confidence and social interaction
- Reduces the risk of long-term visual disability
Consultation for Squint (Strabismus)
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