If the squint is not controlled by glasses, surgery should be considered. Some parents ask if an operation can be carried out as a substitute for wearing glasses. Unfortunately, surgery to correct refractive error is not yet at a stage where it can be applied to children with squints. Squint surgery involves moving the muscle insertions or shortening the muscles and from the cosmetic point of view is highly effective. The adjustment of the muscles is measured in millimetres to correspond with the angle of the squint in degrees. Sometimes two or more operations are needed because of occasionally unpredictable results, but from the cosmetic point of view, nobody need suffer the indignity of a squint, even though a series of operations might be needed. Once the eyes have been put straight or nearly straight by surgery, the functional result depends on the previous presence of good binocular vision and good vision in each eye.
Squint occurs in about 2% of the population and so it is a common problem, but only a small proportion of these cases eventually require surgery. The commonest type of squint in childhood is the accommodative convergent squint associated with hypermetropia and here surgery is indicated only when spectacles prove inadequate. Divergent squints are less common but more often require early surgery.
The aim of treatment for a child with squint is to make the eyes look straight, to make each eye see normally and to achieve good binocular vision. Unfortunately, all too often, the first one of these aims alone is achieved in spite of modern methods of treatment. The fault might lie partly in late referral or difficulty with patient co-operation but better methods of treatment are needed.
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