Squint

By Felicianna Stanley
 ‘Squint = Strabismus ’

• Normally visual axis of the two eyes are parallel to each other in the
‘primary position of gaze’ and this alignment is maintained in all
positions of gaze.

• A misalignment of the visual axes of the two eyes is called squint or

strabismus.
Extra-ocular muscles
• Medial and lateral recti  horizontal eye movement
• Superior and inferior recti  vertical eye movement
• Superior oblique  depression during adduction
• Inferior oblique  elevation during adduction
Importance of proper eye alignment
1. Binocular vision

2. Depth perception (3 –D)

3. Prevent amblyopia (lazy eyes)

4. Avoid diplopia (double vision)

5. Prevent psychosocial dysfunction

 Definition of Amblyopia
Amblyopia is the medical term used when the vision in one of the
eyes is reduced because the eye and the brain are not
working together. The eye itself looks normal, but it is not
being used normally because the brain favors the other eye.
 Squint types
Non paralytic=concommitant
squint.
Esotropia= inward deviation.
1-Congenital.
2-Accommodative (refractive,non-
refractive,mixed).
Exotropia =outward deviation
1-childhood-onset
2-sensory-deprivation.
3-convergence-insufficiency
Paralytic strabismus
3RD( Oculomotor)cranial nerve
palsy(all extraocular muscles
involved except the lateral rectus &
the superior oblique muscle)
6th cranial nerve
(Abducent)=paralysis of lateral
rectus muscle .
4th cranial nerve (Trochlear)=paralysis
of superior oblique muscle
 ESOTROPIA

The left eye is turned

inward—note that the
light reflection in the
eyes is not symmetric

HYPERTROPIA
The right eye is turned
upward—light reflection not
symmetrical
HYPOTROPIA
The right eye is turned
downward-light reflection
in eyes is not symmetric
 Signs & Symptoms
1. Most kids do not complain of eye problem – misalignment noticed by family
member or teacher

2. Eye discomfort/eye strain

3. Double vision

4. Wide field of vision

5. Abnormal head posture

6. Squinting with only one eye

 Examination
• History taking
• Onset
• Family history
• History of fall/head or eye injury
• Vision
• Refractive assessment
• Orthoptic assessment
• Hirschberg Corneal Reflex Test
• Cover test
• Prism cover test
 Hirschberg Corneal Reflex Test

• Use torch light

• Used as an initial screen for strabismus
• How it works:
• Stand several feet in front of child with
penlight shining at eyes
• Light reflection will be at the same point
in each eye
 COVER TEST

• When a squint is present and the fixing eye is covered, the squinting
eye moves to take up fixation

• The test should be performed with the object near (33 cm) and
distant (at least 6 m), as certain squints are present only at one
distance.
 Treatment
• Optical correction • Vision therapy
• To correct refractive error • To improve eye coodination and focusing
• Spectacles or contact lenses • Include office based and home training
procedures

• Surgery
• Change the length or position of the
muscles