Strabismus or squint is a deviation of the eyes. The term is used to describe eyes that are not straight or properly aligned.

*What causes the misalignment?

The misalignment results from the failure of the eye muscles to work together. One eye, or sometimes both, may turn in , turn out , turn up or turn down.

*When strabismus is present, will the eyes always look misaligned?

The deviation may be constant or it may come and go. In young children strabismus may vary not only from day-to-day, but also during the course of a day.

*Should I be concerned if  my infant's eyes roll all over?

At birth, an infant's eyes cannot always focus directly on objects. They may appear to move quite independently at first, sometimes crossing, and sometimes wandering outward. But by the age of three to four months, an infant's eyes should have the ability to focus on small objects and the eyes should be straight or parallel. A six-month-old infant should be able to focus on both distant and near objects.

*What should I do if I notice wandering eyes in my four-month-old child?

If parents notice crossed or wall eyes persisting in a child four months of age, they should immediately take the child to an Paediatric ophthalmologist for an examination. Early medical attention is recommended for another important reason-to rule out the presence of a serious disease, such as a tumour.

*Is strabismus (Squint) present at birth?

Strabismus may be present at birth, it may become apparent at a later age or it may appear at any time in life as a result of illness or accident.

*Why is it important to detect strabismus early?

It is critical that this condition be diagnosed and corrected at an very early age (before 6-8 yrs at the most) since children with uncorrected strabismus may go on to develop lazy eye or Amblyopia, which is a permanent loss of vision.

*What is false or pseudo-strabismus?

Certain children may appear to have strabismus when, in fact, they do not. An extra fold of skin near the inner eye, a broad, flat nose or eyes that are unusually close together may also produce the effect of false (or pseudo) strabismus. False strabismus should disappear as the child's face grows. After a professional examination, a parent's concern can be quickly dispelled if false strabismus is present.

*What treatment is available for strabismus?

Strabismus cannot be outgrown, not will it improve by itself. Treatment to straighten the eyes is required.
The goals of treatment are:

*To restore vision

*To straighten the eyes

*To restore binocular vision

 The types of treatments may be used alone or in combination, depending on the type of strabismus and its cause.

Glasses are commonly prescribed to improve focussing and redirect the line of sight, enabling the eyes to straighten.

Medication in the form of eye drops or ointment may be used, with or without glasses.

Surgery may be performed on eye muscles to straighten the eyes if nonsurgical means are unsuccessful.

Eye exercise, a limited form of treatment, may be recommended either before or after surgery to teach proper eye coordination.

The author is a consultant in Paediatric Ophthalmology and Squint, Samprathi eye hospital and can be contacted at 23367544, 23360099 or  9845423955