Strabismus (Squint)

Means misalignment of the eyes. One’s eye may either be turned in or out, or not! ie pseudo-strabismus. There are various types of strabismus and many different causes. 

In children, it is important to exclude any refractive errors where spectacles may be required as some form of strabismus such as accommodative esotropia can present with in-turning eye.

In the visual assessment, it can be rather challenging to ascertain a child’s vision, particularly when they are non-verbal. Various forms of charts may be used and more importantly, just watching the visual behavior may give an indication if one eye may be weaker than the other in cover test.

• Pseudo-strabismus
  
  

  In this situation, the child is often referred as there is a concern of a turning eye. However, there is no evidence of a true strabismus but impression of a strabismus or squint, often due to broad nasal bridge. 

  Thus when the child looks to the side, for example to the left, the right eye seems much closer to the nasal bridge and gives the impression of an in turning eye and vice versa.

  This can be observed in any child but particularly in Asians with typically broad and flat nasal bridge.

• Intermittent exotropia
  
  

  This very common condition affects either boys or girls equally in incidence. The eye turns outwards when the child is tire, not concentrating or about to go to sleep. It occurs intermittently throughout the day and often looks straight more often than not. 

  The child usually maintains normal vision and the rest of the eye usually completely normal in examination and with no significant refractive error requiring glasses.
  
  

  The management is pretty much regular monitoring of the vision and yearly eye review. Unless the eye turns out permanently, corrective surgery is performed or if the child seems to exhibit an out turned eye more often than not ie more than 50% of the time.