All about squint Strabismus Surgery

Squint Surgery | Strabismus Surgery


What is a squint? What is strabismus?

A squint, medically known as strabismus is where the eyes don’t align properly. It could mean the eyes are pointing in different directions. Sometimes the deviating eye is pointing inwards and sometimes outwards.

This is particularly common in young children. Sometimes it can be permanent or at times it may come and go.

Without treatment, squint is unlikely to get better on its own and may lead to more problems if not treated early on. Usually if left untreated, it can eventually develop into lazy eye (ambloyopia), whereby the brain ignores input from one of the eyes to avoid double vision. Furthermore, if both eyes are not completely aligned it becomes harder for the person to appreciate depth perception. It can also cause confidence related issues due to poor cosmesis.

What are the causes of a squint (strabismus)?

Unfortunately, like most medical symptoms, the exact causes aren’t always known.

Some squints are congenital and others develop one later in life. Some even suggest a genetic link. But the majority of cases, people are mostly born with squint or develop it during the first few months after birth.

This can occur if the child has myopia (short-sightedness), hypermetropia (long-sightedness), or astigmatism (the cornea is not curved properly). This refractive error will typically make the child turn the affected eye inwards in an attempt to get better focus causing squints to occur later on, usually when the child is at least 2 years old.

Other causes could include:

  1. Thyroid eye disease

  2. Muscle disorders such as myasthenia Gravis

  3. Genetic conditions like Down’s Syndrome

  4. Cerebral Palsy

  5. Other brain or nerve problems

  6. Childhood cataract or eye cancer called retinoblastoma

How is a squint diagnosed?

It is always important to diagnose a squint as early as possible. Routine checks to detect eye problems in babies and children should be done.

Various tests can be done to check a child’s vision. Eye drops will probably be used which dilate the pupils before the test is done. Testing of the child’s eye power would be performed.

The Hirschberg test is used to assess whether the patient has squint. This is performed by shining a light in the patient’s eyes and observing where the light reflects off the corneas.

Other tests to find a squint can involve covering and uncovering each eye in turn. This often shows which eye has the squint and how it moves. Very occasionally, if another cause of squint is suspected (other than a congenital squint or one related to refractive errors), a scan of the eye or the brain may be needed.

What are the treatment options for a squint (strabismus)?

A diagnosed squint needs prompt treatment. The younger the patient is, the more effective treatment is likely to be.

Eye patch – this is worn over the good eye to get the other eye, the one with the squint, to work better. This is usually used on patients with a lazy eye as a result of squint. Note: eye patching and other treatments for lazy eye aim to improve vision; they do not by themselves correct the appearance of a squint. Usually, a lazy eye has to be treated first before any correction of squint can occur.

Glasses – if the child is found to have long-sightedness causing squint, glasses can help.

Botulinum toxin injection (botox) – this is injected into the eye muscle. This weakens the muscle temporarily for about 3 months, which often helps the eyes to align properly. The doctor may recommend this treatment if no underlying cause can be identified and if signs and symptoms come on suddenly. This treatment is an alternative to surgery, but only for certain types of squint particularly squints that turn inward.

Surgery – surgery is only used when other treatments have not been effective. Surgery can restore binocular vision, as well as realign the eyes. Surgery involves moving the muscles so the eyes line up correctly.

What is the outlook for a patient with squint?

For lazy eye if it develops:

As a general rule, the younger the child is treated, the quicker the improvement in vision and the child has a higher chance of restoring full vision. If treatment is started before the age 7 then it is often possible to restore normal vision. Otherwise, some improvement in vision may still occur but full normal vision is unlikely.

For improving the appearance of the eyes:

Squint surgery usually greatly improves the straightness of the eyes. In some cases, one or more operations are needed to correct the squint. Sometimes a special stitch is left in place and can be adjusted later on if further correction is needed.


Squint surgery is considered to be a low-risk surgery with a high success rate. Children would need general anaesthesia (total body anaesthesia) for squint surgery. Squint surgery in adults can be done under local anaesthesia. There will be eye discomfort for few days and some redness for 2-3 weeks after surgery. Patients will be given an eye ointment to be instilled in the eye for about a month after surgery.

Our eyes are very important to us.

If you are considering a squint surgery, see an oculoplastic surgeon. An oculoplastic surgeon’s primary focus is the health and safety of your eyes, but they also have unique skills as a plastic surgeon to safely treat your eye area.

If you would like the rewarding experience our patients have experienced, I will be happy to meet with you for a private consultation. At this visit, I will be able to give you a clearer idea of what results you might expect, based on your unique condition and specific needs.

You will also be able to look at photographs of some of our previous patients, review and ask any questions you may have about this procedure. 

Why wait? After all, you have nothing to lose from one consultation. Click here to make an appointment to see me.

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