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Adult Squint

A squint exists when the eyes are out of alignment. It is also known as strabismus or more colloquially as bozeyed or wall eyed. This most common misalignments are convergent (cross eyed) or divergent (eyes going outward). The eyes can also be vertically out of alignment either as a single entity or in combination with a convergent or divergent squint.

Most longstanding adult squints are as a result of having had a squint in childhood, which may or may not have been operated upon (see childhood problems squint section). In the main people want these squints correcting for cosmetic reasons. This usually involves surgery, though using glasses may be required as well. Many people have put up with a squint all their life because they are incorrectly told that surgery is not possible as an adult.

Squints can be acquired as an adult usually as a result of brain problems such as stroke or trauma. That said many squints that start to cause problems in adulthood have in fact been present since childhood. Acquired squints mainly cause problems in the form of double vision. Surgery is not always the answer, prisms are often used and occasionally simply occluding one eye is the only way of preventing the double vision.

An example of adult squint

Picture illustrates a vertical squint where surgery rotates the eye down

Squint surgery.

The majority of adults undergoing squint surgery are doing so for cosmetic reasons.

Many adults put up with a squint because they think it is too late to be corrected by surgery. This is not true. In Derby squint surgery for adults is a common procedure.

In cross eyed squints essentially the in pulling eye muscles are weakened and out pulling eye muscles are strengthened. This rotates one or both eyes outwards correcting the cross eye. The opposite is done for diverging squints. More details are given in the childhood problems squint section. Surgery can be done under local or general anaesthesia and never involves the eye being taken out of the socket. The eye(s) will be red for several weeks’ even months if this was not the first squint operation. However it’s not a particularly painful procedure. In Derby all squint surgery is performed as a day case.

There are many other factors when considering what type of surgery is performed. Whether there has been any other squint surgery previously is important, though most people do not know what type of squint surgery they had as a child. Another factor is whether they used to (and perhaps still should) wear glasses. All these details will be explored by your eye surgeon

For those where the squint is mainly a cosmetic problem, the aim of surgery is to get the eyes looking straight most of the time. It’s rarely possible to completely eradicate the squint at all times, especially when the person is tired or after a few drinks. A successful outcome is when most people do not notice the squint most of the
time. It is inevitable that someone who has had a squint all their life still sees it when looking in the mirror, even after successful surgery.

Like in childhood squints, the main risks of surgery are under correction and overcorrection. In under correction the squint remains noticeable to most people in spite of the surgery. In overcorrection, a convergent squint (cross eyed) squint becomes diverging and vice versa. The risks of this happening are higher in those who have had previous squint surgery. Those people with very small squints are at a greater risk of overcorrection as well because squint surgery is not an exact science.

It is not uncommon for someone undergoing squint surgery to experience double vision in the early stages after surgery. This usually settles down. In a small proportion, especially those who have an overcorrected squint, the double vision may be permanent with further surgery being required. Other risks include infection and damage to the internal structures of the eye. It is possible but extremely rare to have loss of vision as a result of this.

Those experiencing double vision before, or at greater risk of this after the operation may have the surgery performed on adjustable sutures. Here the stitches holding the muscles to the eye are partially tied at the time of surgery. This allows adjustment of any residual or overcorrected squint the next day.

Overall the chance of a good outcome is between 70% and 80%.

Useful link: www.lazyeyesite.org

General eye problems

Adult Squint
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AMD
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Presbyopia and normal ageing of the eye
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Cataract
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Cataract FAQ's
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Refractive surgery of the lens and correction of presbyopia
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Dry eye
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Glaucoma
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Retinal Vein Occlusion

 

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