Squint is a condition in which both the eyes are not looking at the same object. Generally, parents call such a child as cross-eyed. It can cause irreversible visual loss in a child with one eye becoming weak, amblyopia or lazy eye.
Squint can have a deep psychological impact on a child and it is important for parents to exercise discretion in discussing the problem in front of other people and seek opinions. Such children are often bullied by their classmates and need to be given all the support by the parents as well as the teachers. The child must be made a partner in the management plan and necessary confidence generated in him or her to follow the advice. Wearing glasses of appropriate power or occlusion of one eye are important components of management.
The first and foremost part of examination is assessment of power of eyes. Cycloplegic Refraction is done for the child. Depending upon age atropine, cyclopentolate or tropicamide are used for the purpose. In children below 10 years of age, it is mandatory to have refraction under use of atropine in ointment delivery (preferably). Squint that is controlled by glasses only is called refractive squint and no surgery is required in such cases. If there is no significant refractive error surgery is required at an appropriate time after making visual acuity equal in both the eyes. There can be a mixed mechanism also where the refractive component is controlled by glasses and residual corrected by surgery. Occlusion therapy that involves preventing light from entering one eye (the better one) may be required for a certain period under the doctor's guidance. Image fusion training before or after surgery may be administered on a machine called synoptophore.
Timing of surgery has to be planned in consultation wit the treating doctor. The general principle is that child should have stable deviation and equal visual acuity in the eyes. Generally surgery is performed before 6 years of age. Counselling should remain integral part of management.