How will the squint be managed?
The first step is to give glasses if there is a significant refractive error and this may also improve the squint. Patching or atropine drops are used to treat amblyopia if present Squint surgery can be used to improve the appearance of the eyes and in some children can restore some binocular function if done early.
REFRACTIVE ABNORMALITY AND SPECTACLES
The main refractive (focussing) error to be the cause or part of the cause of convergent squint is Hypermetropia (long sight).
Will my child need to wear glasses?
This is decided by the Ophthalmologist (the eye surgeon responsible for the management of your child’s squint) after refraction.
Refraction involves your child first having some drops or ointment to both eyes to dilate the pupils (make them bigger) and stabilise the focussing. Then the doctor measures what lens is needed by shining a special light into the eye and seeing how its reflection is changed. Appropriate lenses are put into a (trial) frame and older children will read the test chart.
Do the glasses have to be worn all the time?
Yes, unless advised otherwise.
How do we obtain the glasses?
You will be given a prescription for glasses which you can take to your own optician or you can visit the spectacle department on the ground floor of the Richard Desmond Centre where they specialise in children’s care and hold a good selection of frames at competitive prices. The prescription issued after a private consultation is not an NHS voucher.
What do we do if the glasses break?
These days all children have glasses with plastic lenses. These are lighter in weight and less likely to break.
EYE MUSCLE IMBALANCE AND OCCLUSION (PATCHING)
In order to focus both eyes on an object all the eye muscles of each eye must be balanced and work together. When one eye turns that eye is not focused properly and the vision can deteriorate in the squinting eye. An orthoptist carries out a series of eye tests to determine the presence of a squint and measure vision. In some children who develop a squint patching or using Atropine to the good eye will make the lazy eye work harder and therefore improve the vision.
How does a patch affect the squint?
Patching purely improves vision by making the brain use the amblyopic eye. The unpatched eye will appear to be straight while the patch is worn. Sometimes when the patch is removed the squint may be temporarily more noticeable, but later returns to the pre-patching position.
Will my child need to wear a patch?
Possibly, if your child is less than about 8 years and if the vision in one eye is reduced because of the squint. This will mean regular follow up visits.
Which eye does the patch need to be put on?
On the straight eye so that the eye with the poorer vision is used on its own for some part every day. It is a very effective way of improving vision.
Does my child wear his glasses with the patch?
Yes, the patch should be worn on the face. It is made from non-irritating material to prevent rashes. Spectacles are worn over the patch.
How long should the patch be worn?
This varies according to the child’s need and may be from less than 1 hour to a day to all day. Close work activities such as colouring, reading or schoolwork should be undertaken during patching. It can be useful to negotiate this with your child’s teacher. It is important that the child is involved in some near vision activity during patching. This will achieve maximum effect and help the child comply with patching because it distracts attention from the patch. Perseverance with patching is vital.
Another way of getting a lazy eye to work is putting Atropine into the good eye to blur the vision and make the weaker eye work harder.
Can exercises cure the squint?
They can hep to control some intermittent squints in older children.
Will an operation help?
Many children with squints do need an operation as well as glasses or patching. The operation is confined entirely to the surface of the eye. The muscles which are attached to the outside of the eye are moved to a new position on the surface of the eye. Usually the muscles of the squinting eye are operated upon, but sometimes it may be necessary to operate on the muscles of the other eye as well, as this may give better results. Often one operation is effective but some children will need further operations. Even an operation cannot ensure perfect alignment afterwards. In any squint surgery the focusing parts of the eye are never operated on and there is no significant risk of your child’s sight being damaged by the operation. For any eye operation the eye is NEVER brought onto the cheek for surgery.
Can you tell us about the hospital stay?
You may wish to visit the Childrens ward before the hospital admission. On the day of admission your child will be seen by the your surgeon and the anaesthetist (the doctor who puts your child to sleep for the operation). One parent is allowed into the anaesthetic room until the child is fully asleep.
Before returning home, the nurse will clean around the child’s eye and instil drops. The doctor will see your child and ensure they are fit for discharge. An appointment will be made for follow up after this. Usually drops will need to be used at home. The nursing staff will show you how to instil drops.