Squint in Childhood

During the first few weeks of life the eyes might seem to wander about aimlessly with limited ability to fix. Between the ages of two and six months, fixation becomes steadier even though the fovea is not fully developed, and by the age of six months convergence on a near object can be maintained for several seconds. Even at birth, some degree of following movement of the eyes can be seen in response to a flashing light, but only the most gross squints can be diagnosed during these early months of life. If the eyes are definitely squinting at the age of six months, urgent referral to an ophthalmologist is indicated. Before this or when there is some doubt, referral to an orthoptic screening service can be considered. These have been set up in many parts of the country. Orthoptists might be regarded as "physiotherapists of the eyes" and they are trained to examine the eye movements in great detail. We need to detect squints early in children for the following reasons:

1. The squint could be caused by serious underlying intracranial or intraocular disease.

2. The squint can result in amblyopia, which is more effectively treated, the younger the child.

3. The cosmetic effect of a squint is an important consideration.

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