Parents of children with squint are often confused and perplexed. They need to visit an eye surgeon and a management plan is to be put in place in collaboration with the pediatrician in charge.

Many a times the child may be having an 'apparent squint' or 'pseudo-strabismus'. The term is self explanatory as many children have a skin fold on the nasal edge of the eye lids and a relatively flat nose bridge. This is especially true of chubby kids.  As they grow the skin fold retracts and the nose bridge gets raised. All it requires is reassurance and a few regular visits to the doctor. Photographs taken from front can be useful in understanding how the corneal reflex from the front of the eye is centered symmetrically.

Squint means that both the eyes are not looking at the object of regard and could be deviating outwards (exo deviation) or inwards (eso deviation).

Many a times exact assessment of visual acuity can not be made in infants, toddlers and pre school children.  An objective Cycloplegic Refraction will be the first step towards management.  Children below 10 years of age should undergo refraction under cycloplegia by Atropine.  It is generally available in 1% ointment form and precaution must be taken to apply it alternately in eyes to avoid toxicity especially fever. Fever may be manged by oral paracetamol syrup.  Prescription lenses are very important for controlling accomodative element of manifest squint.

Sometimes one eye does not achieve full vision on correction which is called 'Amblyopia' or 'slow eye'.  This would be generally managed before embarking on a surgical correction.  Patching of an eye for specified periods may be required as a part of the protocol.  The child must be mentally prepared for the same and family counseled.     

Surgical Correction may be carried out at a suitable age when an accurate assessment of deviation can be made or surgeon explains the reason for an early intervention.

Systemic associations and other ocular anomalies may be ruled out and documented for future reference.

To conclude- Squint management is a process that may start several months before surgery and may continue for a long time afterwards as well. Corrective lenses, orthoptic interventions and visual training are essential for an outcome that may result in preservation of binocular visual function and aesthetically acceptable looks