Squinting In Children

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Squinting In Children
Squinting In Children
Video: Squinting In Children
Video: Squints in Children | Dr. Neepa Thakkar Dave 2023, February

Squinting in children

Squint (strabismus) is a misalignment of one or both eyes. The deviation can be clearly visible from the outside, but also hardly or not at all noticeable to laypersons (so-called microstrabismus). However, treating squint is important from a young age. Because the first years of life are essential for the development of the visual system (vision, visual acuity, depth of vision, etc.). Not all developments that are not made in the first time can be fully made up for later. There is a risk of lifelong impairment.


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  • Squint - what is it?
  • Consequences of squinting
  • How is the diagnosis made?
  • How is the treatment carried out?
  • Whom can I ask?
  • How are the costs going to be covered?

Squint - what is it?

The misalignment of the eye can be different when squinting, inward (inner squint), outward (outer squint), up or down (vertical squint) or by twisting around the visual axis (curling squint).

Strabismus is noticed immediately by the deviation of the eye. The deviation can, however, also hardly be noticeable or not at all for laypeople, because it is little or not visible from the "outside". Nevertheless, it has to be corrected so that “correct” vision can be learned and the information can be stored correctly in the visual center of the brain. Particularly in the case of small children, it is often not possible for parents to clearly assign information. For example, squinting the affected eye and tilting the head may indicate strabismus, but also have other reasons.

It is therefore advisable to have the ophthalmological examinations of the mother-child passport (10-14 months old, 22-26 months old)

as well as to consult the ophthalmologist in the event of complaints, abnormalities or suspicious factors.

Some causes of strabismus are not yet fully understood. High ametropia (not corrected or corrected too late), unequal refractive errors (e.g. one eye is farsighted, one nearsighted), injuries and eye diseases can be possible causes.

Consequences of squinting

On the one hand, externally strongly visible strabismus can lead to disadvantages. On the other hand, the first seven years of life are essential for the development of the visual system, for visual acuity and three-dimensional vision. Developments that are not made during this time can often no longer or only partially be made up later (e.g. the correct learning of three-dimensional vision). There is a risk of lifelong impairment.

Normally, a “correct” image is created through visual impressions of both eyes, which are brought together in the brain. For this it is necessary that both eyes look in the same direction, i.e. stand parallel, and are therefore directed to the same point (when looking into the distance). This is not the case with squinting. If the difference between the images to be processed becomes too great, double images arise. The information from one of the two eyes is suppressed in order to avoid these double images. The "less used" eye can become amblyopic over time. For more information, see Amblyopia. The consequences of strabismus - for example, weak vision - can persist if it is not treated in time.

How is the diagnosis made?

The ophthalmologist can use various tests to examine the eyes and diagnose or rule out strabismus (cover test). Further tests carried out are adapted to the age (e.g. Lea test, E-hook test, Lang test, etc.).

In the course of an ophthalmological examination of children, a preliminary examination can be carried out using a special device (autorefractometer). The position of the eyes, mobility, two-eyed vision, close focus, etc. are clarified.

In order to check the refraction of light by the eye (refraction) and to determine the strength of the glasses, the ophthalmologist works with a shadow sample (retinoscopy). For a detailed examination of the eyes of children, pupil-dilating eye drops are used. These drops temporarily more or less strongly disable the muscle that focuses the eye for different distances (accommodation). The use of the eye drops is an important prerequisite for carrying out the examination. Children's eyes can still accommodate very well, which is why ametropia or weak vision can often go unnoticed for a long time without this detailed examination.

How is the treatment carried out?

The treatment for strabismus consists of:

  • Correcting the refractive error (s) caused by wearing glasses,
  • Masking treatment or treatment of poor eyesight (amblyopia),
  • Surgical intervention (strabismus surgery - eye muscle repositioning).

In the masking treatment (occlusion therapy), the non-squinting eye is covered with a plaster according to the instructions of the attending physician (e.g. on an hourly or daily basis) in order to exercise the other eye. It must be completely covered, ie, for example, only darkening the lens is not effective.

Training, regular follow-up checks and the cooperation of the child or parents / guardians are necessary for an optimal result. The treatment can be tedious and sometimes take years.

For some people, an operation on the eye muscle can correct the position of the eye. The doctor will inform you about the surgical procedure.

Whom can I ask?

Ophthalmologists (also: ophthalmologists, specialists in ophthalmology) diagnose and treat strabismus.

The treatment can also be carried out in specialist outpatient clinics or specialized outpatient departments and departments of hospitals (visual school). Orthoptists can be involved.

Pediatricians and family doctors can initiate referrals.

How are the costs going to be covered?

The costs of visiting a doctor to diagnose strabismus as well as the strabismus treatment are normally covered by the social security agencies.

Further information on the cost coverage of glasses can be found under ametropia, e.g. under myopia. For information on the respective provisions, please contact your health insurance provider, which you can find on the social security website.

Further information on cost coverage for care by orthoptists can be found under Orthoptist.

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