ADULT SQUINT

Adults can have squints for a number of reasons.  It is possible that there is a pre-existing squint in childhood that is either worsened or changed in type as the patient has got older. Some patients develop squints, either horizontal or vertical following head injuries or other neurological episodes.  Some patients have had surgery for a squint in childhood and their eyes have progressed so that the squint becomes consecutive. This means that a child who had surgery for a convergent squint (eyes turning together) becomes divergent (eyes turning apart) in adulthood. Adults can develop squints (usually divergent squints) if the vision is poor in one eye. That eye will tend to drift outwards.

Ian Simmons operating

WHAT SYMPTOMS WILL CAUSE A SQUINT?

If there has been a gradual onset of the squint, family and friends might not necessarily notice and in which case the squint may become most apparent on photographs.  If squints are large enough, they will be noticed as a cosmetic or appearance issue either by the patient him or herself or by others.

 

If the patient has not had a squint in childhood and then develops a squint in adulthood, it will commonly cause double vision.  If the eyes are vertically displaced it will cause vertical double vision such as one line of teletext print on top of the other if you were watching the television. If patients who had had a head injury with vertical double vision, the problems are worst when looking down to read.  A patient might have horizontal double vision with the two images sitting side by side.  A weak muscle on the outside part of the eye (lateral rectus) may lead to double vision which is worse looking in one horizontal direction than another and the double vision tends to be more noticeable for objects in the distance rather than for those nearby.

WHAT INVESTIGATIONS ARE REQUIRED?

  • All patients with a squint, be they children or adults, require a full orthoptic assessment.  Mr Simmons works with Mrs Margaret Lye, a Senior Orthoptist who he also works with at St. James University Hospital. Mrs Margaret Lye is based at Spire Leeds Hospital. She will perform a full range of orthoptic examinations and tests, which will clearly measure the angle of the squint. She may offer some orthoptic treatment in the form of exercises or the use temporary prisms that could be stuck on a pair of glasses.


  • Occasionally, particularly for adults with a sudden onset of double vision and a squint it may be necessary to perform a head scan (a CT or MRI scan) but this is an unusual requirement.  Occasionally some blood tests are required particularly to look for generalised muscle weakness or hormone imbalance.

 

EYE-GRAPHIC

HOW ARE SQUINTS TREATED?

Mr Simmons will establish what the principle reason for doing squint surgery is. This might be to improve the cosmetic appearance of the eyes or it might be to try and reduce and relieve double vision. 

Mr Simmons may work with Mrs Lye to develop a conservative treatment approach using glasses, prisms and/or exercises.  Sometimes prisms and glasses will be used as a diagnostic test whilst preparing a patient for squint surgery.

Occasionally, Mr Simmons may advise the use of an injection of Botulinum Toxin in a muscle around the eyes. This can be used to mimic the surgery that can show a patient what it would be like if a definitive operation were carried out.  This injection is usually done under local anaesthetic as a day procedure.

Definitive treatment of the squint involves re-balancing the eyes by re-positioning the muscles. To weaken a muscle it is taken off from its attachment on the eyeball itself and moved backwards. In so doing no material is removed from the eye and as such the operation is reversible. The strength of a muscle it may be brought forwards (if it has already been weakened) or a piece may be taken out to shorten it.  This operation can be considered partially reversible as further surgery can be performed on the same muscle.  If there is doubt as to where the eye may end up after surgery, Mr Simmons may discuss the possibility of adjustable sutures. This is where a loop stitch is used to attach one of the muscles to the eye and this stitch can then be adjusted the following day under local anaesthetic.  This is certainly not for everyone and is not required in all types of squint surgery.  Mr Simmons will discuss the options of using adjustable sutures with you.

AM I EVER TOO OLD TO HAVE SURGERY?

As for cataract surgery, there is no age limited for a squint operation.  There is an option to have squint surgery performed under local anaesthetic and this is often taken up as an option for patients over the age of 70.  Just as you are never too old to have squint surgery, there are always further operations that can be contemplated or discussed. Mr Simmons would be happy to discuss the options with you.

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