All You Need to Know About Squint Surgery

Squint surgery is a permanent and effective solution for crossed eyes, not to be confused with “lazy eye.”

People often apply the term “lazy eye” to both strabismus and amblyopia. But this is a huge misconception. Lazy eye and squint are popular topics that are often misunderstood and can be confusing.

WHAT IS A SQUINT?

A squint, also called strabismus, is an eye condition where the eyes point in different directions. It is commonly known as crossed eyes, drifting eyes, or wandering eyes.

The main symptom is pretty obvious. It may be in one eye only or both eyes. One eye can turn out (divergent), in (convergent), up, or down. For example, exotropia is a type of strabismus in which one or both eyes turn outward. This is the opposite of crossed eyes, or esotropia.

Also, strabismus may be constant or happen from time to time (intermittent).

The exact cause of a squint is unknown. Squints are particularly common in young children (congenital), though. Sometimes they run in the family or are more frequent if you have long-sightedness – difficulty seeing nearby objects.

A squint can also be a symptom of a rare type of childhood eye cancer called retinoblastoma. However, you could develop it in adulthood due to a medical condition (acquired). Hence, it can occur at any age.

Written by Dr Osama Bahsas Zaky
Updated on October 26, 2021

What is a Squint?

Treatment Options.

What is Amblyopia?

Strabismus vs. Amblyopia.

The Surgical Procedure.

Aftercare from Surgery.

The Recovery.

Complications and Risks.

How Much does Squint Surgery Cost?

WHAT ARE STRABISMUS TREATMENT OPTIONS?

Not all squints need surgery. But a squint should always be evaluated by an eye doctor for a series of simple tests and treatment, if necessary.

Depending on the type of squint, it may cause double vision, headaches, or cosmetic concerns due to the eye’s appearance. Glasses can help if a squint is caused by a refractive error, such as long-sightedness.

Surgery to correct a squint is recommended if other treatments (glasses, prisms, or eye exercises) are not ideal or do not help. It involves adjusting the muscles (on the outside of the eyeball) that control eye movement to perfectly align the eyes.

Surgery can improve the alignment of the eyes even if it has been delayed for a long time. However, any vision problems may be permanent if strabismus is not treated at a young age.

Normal alignment can improve vision, depth perception, communication skills, and quality of life.

WHAT IS AMBLYOPIA?

Amblyopia, commonly known as lazy eye, is a problem with visual acuity or eyesight. One eye (more common) or both eyes may be affected and have poor vision. Since the brain cannot effectively combine the images from both eyes, the brain starts to ignore (turn off) the signals coming from the affected eye, so a child does not develop normal eyesight.

Also, as the brain ignores the affected eye, it becomes lazy from lack of use. Hence the name. So, amblyopia is a functional vision problem that may also present with poor depth perception, squinting, constant head turns, eye strain, or fatigue.

Amblyopia can only be treated when the patient is a child, ideally under age 6. The sooner, the better! Glasses, eye patches, and vision therapy are the most common treatments for lazy eye. Wearing a patch over the unaffected eye help improve vision in the affected eye.

What is The Difference Between Amblyopia and Strabismus?

Amblyopia and strabismus are two terms commonly confused and used interchangeably.

Lazy eye is amblyopia, meaning poor vision in one or both eyes.

Strabismus is the most common cause of amblyopia, and amblyopia often presents with strabismus.

Since the weaker (lazy) eye can’t see well, it may start to drift or wander outward, inward, upward, or downward. Hence, amblyopia can lead to eye misalignment.

However, amblyopia can occur without strabismus or any outward signs. So, lazy eye cannot be treated with surgery. It can only be treated with a patch or glasses when the patient is a child.

HOW IS THE SQUINT SURGERY PROCEDURE?

Before the procedure, the patient will attend a pre-operative assessment to confirm the diagnosis and that everything is ok before surgery.

Strabismus surgery is performed under general anaesthetic and usually takes less than an hour. Most surgery is done on an outpatient basis, so the patient can usually go home the same day.

During surgery, the eye is held open using an instrument known as a lid speculum. In most cases, it is necessary to operate on both eyes to get the right alignment.

The tissue (conjunctiva) over the white part of the eye (sclera) is cut open with scissors to expose the muscles underneath. These muscles control the movement of the eye. Usually, two muscles are adjusted. One muscle is strengthened, and the other is weakened. The eye surgeon detaches part of the muscle connected to the eye and moves it to a new position so that the eyes move and track together normally.

Then, the eye muscles are fixed in their new position using dissolvable stitches. The sutures are hidden behind the eye, so they are not noticeable.

Sometimes, in adults and teenagers, adjustable sutures are used to fix over or under-correction postoperatively. Your doctor can get the eye position exactly right by pulling or loosening the stitches. But don’t worry because local anaesthetic eye drops are used to numb your eyes for this.

WHAT TO DO AFTER YOUR SQUINT SURGERY?

You will wake up with a pad over the treated eye. This is removed the next day or before going home. To prevent infection at home, you will have to use eye drops 3-6 times a day for 2-4 weeks following surgery. Also, try to keep soap or shampoo out of your eyes when washing!

There could be some discharge from the eye(s) operated on, though. This is normal and doesn’t mean that it is infected. The eye will be sore for at least a few days, but OTC painkillers are enough. You will also feel like grit or sand in the eye. But try not to rub your eyes because this could loosen the stitches and cause infection.

Also, red eyes (blood-shot) are common and will increase over the first two days after the surgery. These can even last for a couple of months. Lastly, double vision is pretty frequent but temporary. It usually subsides after a week.

A post-operative appointment will be arranged two weeks after the surgery.

WHAT TO EXPECT AFTER SQUINT SURGERY?

It can take several weeks to fully recover from surgery. The eyes may appear better aligned right after the surgery. However, they will often move in and out as they settle, and the brain “re-learns” to control the eyes. This can last a few days to a week or so.

  • You can resume visual activities like watching television and reading right after surgery.
  • You can return to work or school as soon as you feel ready, after about a week. However, you won’t be allowed to drive for at least a day or two or even longer if you have double vision.
  • You should avoid swimming and contact sports for 2 to 4 weeks.
  • You should avoid dirty and dusty environments for a minimum of 2 weeks.
  • Do not use make-up close to the eyes for four weeks.
  • Do not wear contact lenses until your doctor tells you it’s safe.

IS SQUINT SURGERY RISKY?

Squint surgery is a safe procedure, and complications are rare. And, in any case, they can be treated effectively. Complications may include over or under-correction, double vision, or infections.

If the defect is over or under corrected, you can have another surgery. This complication may occur because the stitch(es) get loosen.

Double vision (diplopia) is common after surgery. On rare occasions, it can be more persistent or permanent. Lastly, loss of sight after a squint operation is extremely rare, happening in 1 in 20,000 cases.

How much does Squint Surgery cost?

Squint surgery cost depends on the technique performed. Please, fill in the contact form. If you have any medical reports or examination results from other centers, we would appreciate it if you could send these tests to us by email.

You can be sure that this information will always be treated with maximum confidentiality, and we will offer you the solution that best suits your needs.

BEST STRABISMUS AND AMBLYOPIA SPECIALISTS IN SPAIN:

Doctor Juan José Rodríguez Ezcurra

Doctor Juan José Rodríguez Ezcurra

Bachelor of Medicine and Surgery (1974) and specialist in Ophthalmology (1977). Courses specializing in strabismus surgery and ocular motility, pediatric ophthalmology and neuro-ophthalmology. Coordinator of the Ocular Motility and Strabismus at the Barraquer Ophthalmology Centre Unit. He teaches at the courses of the Institut Universitari Barraquer. Member of various medical societies. He has presented numerous courses and congresses of the specialty.
Languages: Spanish, Catalan, French, Italian
Association number: 10.116

Doctor Idoia Rodríguez Maiztegui

Doctor Idoia Rodríguez Maiztegui

Bachelor in Medicine and Surgery (University of Barcelona, 2006). Specialization in Ophthalmology at the Barraquer Ophthalmology Centre (Barcelona, 2011). Four different Masters in ophthalmic subspecialties at the Institut Universitari Barraquer “Retino-Vascular Pathology, Inflammation and Intraocular Tumors”, ” Cornea Pathology and Ocular Surface”, “Pathology and Surgery of the Macula, Vitreous and Retina” and “Diagnosis and Treatment of Cataract and Glaucoma”. Fellowship in the Department of Eye Motility and Binocular Vision at the Barraquer Ophthalmology Centre. Observership in the Department of Strabismus and Pediatric Ophthalmology at the Bascom Palmer Eye Institute in Miami (USA). Professor of Ophthalmology Training of the International University of Catalonia.
Languages: Spanish, Catalan, English, French
Association number: 42.251

External links – Bibliography

Surgery and botulinum toxin in congenital esotropia. Ruiz MF, Alvarez MT, Sánchez-Garrido CM, Hernáez JM, Rodríguez JM.

Horizontal gaze palsy and progressive scoliosis in a patient with congenital esotropia and inability to abduct. A case report. Fernández-Vega Cueto A, Rodríguez-Ezcurra JJ, Rodríguez-Maiztegui I.

Amblyopia. Doshi NR, Rodriguez ML.

Consecutive strabismus after infantile nystagmus syndrome surgery and potential risk factors. Gómez-Mariscal M, Hernández-Martínez P, Rodríguez-Del Valle JM, Ruiz-Guerrero M, Márquez-González C, Rodríguez-Sánchez JM.

DO YOU WANT MORE INFORMATION ABOUT SQUINT AND AMBLYOPIA?

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