Squint

Overview of Squint

Squint produces when both eyes are not aligned in one direction. The eyes can be upward, downward, inward or outward, depending on the condition.

Signs and Symptoms of Squint

Squint meaning in Urdu (Bhenga hona / بھینگا ہونا) refers to a condition due to the misalignment of both eyeballs. One eyeball is inwards, upwards, downwards or outwards direction while the other focuses at one spot. It is also known as strabismus or crossed-eyes.
Squint can be caused by problems with eye muscles, and affects the brain nerves that control the eye muscles. It is also associated with other conditions such as diabetes, high blood pressure, multiple sclerosis, myasthenia gravis or thyroid disorders. It can be seen either at a specific part of the time (intermittent squint) or all the time (constant squint).

Prevalence of Squint

In Pakistan squint is more common in children between the ages of 6-15 years. The overall prevalence of squint in children is about 6.2% according to the total number of patients reported in the tertiary care hospital of Karachi.
According to different surveys, the global prevalence of strabismus is about 2%-5% in the general population. But it is more common in children and old age people. The incidences of squint vary in each category worldwide are as follows:

  • The no of cases reported between the age of 55-75years is about 6.1%
  • For young children cases reported between the age of 1-3 years account for 1.9%
  • The adult's cases reported between the age of 4-54 years estimates 3.3%

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Types of Squint

General symptoms of squint or strabismus may involve:

  • Misaligned eye balls
  • Eyes are not able to move together
  • Frequent blinking or squinting, especially in bright sunlight
  • Moving the head at different directions for looking at the things
  • Poor depth perception
  • Double vision

Symptoms of Squint in Children 

The squint can be a congenital condition, present at the time of birth or appears 6 months after the birth. The sign of a squint is observed at an early age in which the direction of the eyes are changed. Another sign is the double vision. This is observable when one eye is closed and turns the head in different directions for looking at the objects.
As the squint is left untreated then it leads to amblyopia or lazy eye, in which the brain is not transmitting signals to one of the eyes. Therefore, most doctors may recommend the eye patch over the eye to improve vision. Sometimes childhood squints can recur in adulthood.

Causes of Squint

The following terms refer the strabismus according to the different positions of the eye:

  • Hypertropia produces when the eye turns into upward direction
  • Hypotropia produces when the eye turns into downward direction
  • Esotropia or convergent squint results from when the eye turns into inward direction
  • Exotropia or divergent squint results from when the eye turns into outward direction

Other types of squint are categorized according to the duration, direction or underlying cause of the squint. Some of them are as follows:

  • Constant and Intermittent Squint-  In this type, if the squint appears periodically it is called intermittent squint. But if the squint appears permanently then it is known as constant squint.
  • Manifest and Latent Squint- Manifest squint occurs when the eye is open while latent squint appears when the eye is covered.
  • Concomitant (non-paralytic) and Incomitant Squint (paralytic)- These types are classified on the specific type of eye muscles. Concomitant squint appears when the angle of squint remains the same but people can see in all directions. On the other hand, an incomitant squint appears when the angle of squint changes related to its direction. Incomitant strabismus, or paralytic squint, present in both groups childhood and adulthood caused by neurological, mechanical or myogenic problems affecting the eye muscles (controls the eye movements). In comparison to this, concomitant non-paralytic squint is congenital; means appears in newborns or children.
  • Accommodative Squint- This undergoes in the esotropia type. It is observed in very farsighted children. They have difficulty seeing the nearby objects.
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Risk Factors of Squint

Strabismus can be caused in different ways:

  • Congenital, means present when the babies are born
  • Hereditary means, People with this problem may have a family history
  • Due to illness or long-sightedness
  • Formation of the lesion on a cranial nerve
  • Refractive error of the eye means the light cannot focus on the lens of the eye

Other conditions that can cause strabismus:

  • Myopia or short-sightedness is unable to see far away
  • Hypermetropia or long-sightedness in which inability to see the nearby objects
  • Astigmatism, where the shape of the cornea is not curved
  • Hydrocephalus, due to the accumulation of cerebrospinal fluid builds up in and around the brain
  • Viral infections also lead to strabismus such as measles
  • Other conditions include Noonan syndrome and some other genetic conditions such as down’s syndrome

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Prevention

Following factors that can increase the risk factors of squint:

  • Squint in the family like parents, relatives or siblings
  • Brain disorder or tumour
  • Stroke or brain injury
  • Lazy eye
  • Damaged retina
  • Diabetes

Complications of Squint

  • Eventually leading to lazy eye
  • Losing vision
  • Having a double vision overtime
  • This condition can also take a toll on mental health that may result in low self esteem.
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Diagnosis

There’s no way to reduce the risk of squinting until or unless people wear protective things such as safety goggles during risky activities.
Another way to protect it is early diagnoses of the eye or performing an eye exam regularly for another eye disease. Early treatment can be preventable for squint eyes.

Treatment of Squint | When to Consult a Doctor

An ophthalmologist will examine the eyes through different tests. In order to prevent vision loss, early diagnosis and treatment of squint is needed. If a person observes the symptoms of squint then immediately perform the following eye test:

  • A corneal light reflex test for examination of squint
  • A visual acuity test is to determine the ability to read from a distance.
  • A cover/uncover test for the measurement of eye movement and deviation
  • A retina exam to examine the backs of eyes

If the physical symptoms of squint appear along with other conditions then a doctor may examine the brain and nervous system as well. This is done by performing the different tests such as an MRI or CT scan of the brain.
Squint is most common for newborn babies. A simple eye examination is conducted in which the doctor will test alignment by comparing the position of light reflecting off each eye. As the infants are less likely to cooperate that’s why it may be diagnosed by observing the behaviour of them. For young children who can cooperate with the doctor for both intermittent and constant squints can be detected by cover or uncover of eyes test and alternating cover tests. These tests examine the response of the child as it stares at one object with covered and uncovered eyes.

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Last updated on Tuesday 25/10/2022

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Dr. Mehvash Hussain

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