Squinting

Squinting, also known as strabismus, is a misalignment of the eyes that look in different directions. The eyes can be either both inward or outward.

Squinting

What is squinting?

For many of those affected, squinting is not just a “cosmetic blemish”, but it can also be a visual impairment.┬áSee deluxesurveillance for Misaligned Jaw (or Misaligned Teeth) Guide.

Since one of the two eyes is no longer parallel to the other when you squint, you both look in a different direction. Deviation can be in any direction, but the most common are horizontal deviations, which result in either inward or outward squinting.

Since squinting without treatment can lead to severe visual impairment in a healthy eye, timely treatment is particularly important for children. Squinting can be divided into three forms: latent squinting, accompanying squinting and paralytic squinting.

Causes

Squinting can have various causes; this also depends on the form of the squint. The cause of the accompanying squint and the latent squint lies in a disturbed equilibrium of the eye muscles.

However, there are no precise reasons for the accompanying squint, but genetic factors also play a role here. Often one finds in the relatives of the affected person another person who squints or used to squint.

Farsightedness or nearsightedness can be present at the same time. With latent strabismus, the eye cannot merge visual impressions as well, which occurs especially when the eyes are tired or strained for a long time.

Paralytic squinting is a paralysis of the outer eye muscles, which can be caused, for example, by birth injuries, tumors, inflammation or circulatory disorders.

Symptoms, Ailments & Signs

Due to their stage of development, small children can suppress the visual impression by squinting for a certain time. Suppression is considered a protective mechanism and prevents double vision. However, the long-term suppression of the deviating eye provokes the development of amblyopia (lazy eyesight). Affected are children with a one-sided gaze shift.

The more dominant and frequently used eye is preferentially used by the brain. As a consequence, the vision of the inferior eye deteriorates over time. The drop is sometimes so drastic that even large objects are only recognized with difficulty. A similar course can be observed at a young age with the so-called paralysis misalignment.

In general, squinting not only results in an aesthetic impairment, but also always leads to a visual impairment. The first signs of strabismus are trembling eyes and a tilted head position. Sensitivity to light, frequent cases of headaches and loss of concentration are added. Burning eyes and constant blinking accompany a subsequently manifested reading disability.

Latent squinting only comes to light under certain influencing factors such as stress, overexertion or alcohol consumption. This hidden variant causes rapid fatigue and blurry visual impressions with a penchant for double contours or images. This description applies in particular to squint acquired later in adulthood.

Paralysis in adults leads to sudden squinting and visual impairment (double vision) in combination with nausea and dizziness. Those affected often adopt a compensatory head position to relieve the diseased eye.

Diagnosis & History

Due to the visible misalignment of the eyes, a squint can be quickly diagnosed. In order to be able to precisely determine squinting, various eye tests are carried out, such as the covering or uncovering test.

One eye is covered and the doctor can then observe whether the other eye can adjust itself; in this case, it is an accompanying squint. The uncovering test determines whether the eye is moving too slowly during the fusion and whether there is a latent squint.

However, the tests described can also be used to identify other visual disorders. The further course of strabismus depends, among other things, on early therapy. For example, squinting in childhood without treatment can lead to permanent ametropia, which can then no longer be corrected after primary school age. Therefore, squinting should at best be recognized in preschool age, so that the prognosis for sharp and three-dimensional vision is as good as possible.

Complications

Left untreated, squinting in children can have serious consequences. The unused eye often develops a pronounced visual impairment, which will remain permanently if no countermeasures are taken in good time. This is usually accompanied by headaches, which can develop into chronic migraines. If squinting occurs later in life, serious vision problems can occur.

A restricted view increases the risk of accidents and, in general, severely restricts those affected in everyday life and in their professional lives. Squinting also has psychological consequences. The affected person often suffers from exclusion and as a result often develops an inferiority complex or depression. The surgical treatment of strabismus can lead to loss or blindness. Injuries to the eyeball as well as bruises and scars are also conceivable.

Very rarely does vision deteriorate after surgery. Under certain circumstances, squinting is over- or under-corrected and double vision persists or even increases. There is also a risk of over- or under-correction with aids such as squint glasses. Shortly after the procedure, complications such as pain, bleeding or inflammation of the eye are possible.

When should you go to the doctor?

Squinting in one eye is not an independent clinical picture, but a symptom of an underlying disease. In most cases, squinting in one eye occurs at birth. One eye has more vision than the other, so squinting can occur. A specialist doctor should be consulted immediately and without delay so that complications do not arise later in life. Under certain circumstances, the eyesight deteriorates, so that squinting can increase within a short time. However, squinting can be treated effectively and quickly with appropriate treatment.

The course of the disease is completely different if you do without a visit to the doctor. In this case, squinting becomes more pronounced and vision impairment may even occur. If a specialist is still not consulted, in the worst case this can lead to loss of vision. If you want to avoid these and other complications early on, you should consult a doctor early on.

Treatment & Therapy

The form is also decisive in the therapy against strabismus . The treatment of accompanying squinting focuses on stereo vision, which means that the merging of visual impressions and three-dimensional vision is more successful again.

Also, the misaligned eyes are corrected to the normal position. Squinting in children is always treated conservatively at first. For example, with the help of glasses and through a specific eye training, whereby the fusion or the merging of individual visual impressions should be improved again.

What is also used to improve the misalignment of the eye is occlusion therapy, in which one eye is alternately covered with a plaster. However, this taping must be done on a specific schedule. The weaker eye is thus forced to see and children can learn to see well again.

In adults, fusion training is achieved by sticking a matte film to a lens. Thus, double images can be prevented. Anyone who suffers from severe squinting can also consider eye muscle surgery.

This procedure is often performed when binocular vision can no longer be achieved with conservative therapy. Paralytic strabismus is treated similarly, if it doesn’t even resolve on its own after several weeks.

Prevention

Squinting can not be prevented. The consequences of existing strabismus can only be reduced prophylactically by starting therapy at an early stage. This applies above all to children, since strabismus occurs and is detected primarily in childhood.

In the case of strabismus, consistent follow-up care is advisable in order to avoid a possible recurrence of the symptoms after successful treatment. This is especially important for children, as the condition of their eyes changes as they get older. Should the squint come back after the therapy has been completed, further treatment options will be discussed during follow-up care. A second operation may be necessary.

Aftercare

Follow-up care after strabismus surgery is useful to monitor the healing process. Therefore, the patient presents to his ophthalmologist about a week after the operation. During the follow-up examination, it is checked to what extent the eye has already gone down and the current condition after the operation corresponds to expectations.

In addition, the ophthalmologist treats the usual symptoms after an operation during follow-up care. The pain in the operated eye is counteracted with the help of drops or medication. The conjunctiva are swollen after a squint operation. Regular checks are important to prevent or treat inflammation and irritation.

In the case of cross-eyed children, the ophthalmologist will do exercises to increase the eyesight and thus permanently improve the condition of the eyes. This school of vision is used with children up to 15 years of age. After that, the visual acuity no longer changes.

You can do that yourself

In everyday life, the environmental influences when reading, working on a screen or watching TV should be tailored to the natural needs of the human eye. The lighting conditions should be checked and the distance between the person and a legible element should be optimised. Lighting conditions that are too bright or too dark put more strain on the human eye than is advisable. This can cause problems or further impairment of vision.

If the squint is not very pronounced, you can aim for an improvement through targeted eye training on your own. Reading with just one eye is a common technique that can be used independently at any time. Alternately, texts or images should be fixed with the right and then with the left eye. Overall, it is always important to ensure that both eyes are stressed equally if possible. Avoid overloading just one eye.

In children in particular, the misalignment of the eyes can be corrected by specifically influencing the visible area. A consciously aimed at and self-initiated squinting of the eyes should be avoided by people of any age. This process can exacerbate existing problems and have a negative impact on any therapy.