Home › Specialities › Children and squint › Squint surgery

Squint surgery: when it is needed and what to expect

A squint (strabismus) means the two eyes do not point in the same direction. Six small muscles on the outside of each eye move it, and if they do not work in balance, one eye turns in, out, up or down. Some squints are corrected with spectacles or other treatment; others need an operation on the eye muscles. This guide explains when surgery is advised, how it is done and what recovery is like. For children's eye care in general, see children's eye care and squint treatment in Vasco.

Why treat a squint?

• To protect vision in children. The brain may ignore the turned eye, which becomes lazy (amblyopia). This needs treatment while the child is young.
• For depth vision. Eyes that line up can work together for 3D vision, which helps with sport, stairs and judging distances.
• To relieve double vision in adults, where a squint can make you see two of everything.
• For comfort and confidence. Children and adults with a visible squint are often teased or feel self-conscious, and some tilt or turn their head to see well.

Does every squint need surgery?

No. The eye doctor first finds the cause and the type of squint, and many are treated without an operation:

• Spectacles. In some children, an inward turn is caused by long sight, and wearing the full spectacle power straightens the eyes partly or fully.
• Patching for a lazy eye. A squint operation does not treat a lazy eye, so patching often comes first, or continues after surgery.
• Eye exercises help some eye-focusing problems, such as difficulty turning the eyes inward for reading, but they do not correct most squints.
• Prism lenses in spectacles can help some adults with small squints and double vision.

Surgery is usually advised when the squint stays large despite spectacles, is constant, is getting worse, causes double vision, or affects how a person feels and lives.

What is the right age for squint surgery?

There is no single right age. For some squints that start in infancy, surgery in early childhood gives the eyes a better chance to work together. For others, the eye doctor waits for spectacles and patching to do their work first. Adults can have squint surgery at any age, when the eye doctor advises it.

What happens before surgery?

• The squint is measured, usually on more than one visit, because the size can vary.
• Spectacles are updated and a lazy eye is treated first, if needed.
• Your general health is checked before the operation, and your medicines are reviewed. Tell us about any blood thinners; do not stop them on your own.
• The anaesthesia is planned. Children's squint surgery is done under general anaesthesia (the child is asleep), given by an anaesthetist. Adults may have local or general anaesthesia. The surgeon and the anaesthetist explain the plan.

How is squint surgery done?

A common worry is that the eye is taken out during the operation. It is not. The eye stays in its socket. The surgeon makes a small opening in the thin, clear skin over the white of the eye (the conjunctiva), reaches the muscle, and moves it to a new position or tightens it, to change the pull on the eye. Dissolving stitches are usually used. There is no cut on the skin of the face. Sometimes muscles on both eyes are adjusted, even when only one eye seems to turn. The operation usually takes about an hour or less, depending on how many muscles are treated, and most people go home the same day.

What is recovery like?

• The eye is red, scratchy and watery for a few days. The redness can take some weeks to fade completely.
• Eye drops are used for a few weeks, as prescribed.
• Most children are back at school in about a week, and most adults back at desk work within a week or so.
• Do not swim in the sea or a pool for at least two weeks, or as advised, and keep dirty or soapy water out of the eye.
• Avoid rubbing the eye, and keep young children from poking it.
• Adults may see double for a short time while the brain adjusts.
• Follow-up visits check the alignment. Spectacles and patching usually continue afterwards, as advised.

What are the risks?

Squint surgery is a common operation, but like any surgery it has risks, which the surgeon will explain for your eyes:

• the eyes may be under-corrected or over-corrected, and some people need a second operation
• double vision, which is usually temporary in adults
• redness or a small scar on the white of the eye
• infection or an allergic reaction to the stitches
• rare serious problems, such as damage to the eye wall or a slipped muscle
• the risks of anaesthesia

A squint can also slowly return over the years, especially if spectacles are not worn as advised.

Squint in adults

Some adults have had a squint since childhood that was never treated, or that returned. Surgery can improve the alignment, may widen the field of vision and can relieve double vision. A squint or double vision that appears suddenly in an adult is different: it can be a sign of a nerve, thyroid or brain problem, and needs a prompt examination; see optic nerve and double vision problems.

How do I book a squint check-up?

Start with a squint check-up. ReNew Vision Eye Hospital, 2nd floor, Pai Hospital building, Vaddem Merces Road, Vaddem, Vasco da Gama. Eye OPD Monday to Saturday, 4 pm to 7 pm. Call or WhatsApp 072489 88039. Bring current spectacles, old eye reports and, for a child, any photographs that show the squint, which help when the turn comes and goes. Signs that a child needs an eye check are in signs your child needs an eye test; spectacle tips are in spectacles for children. Directions are on the visit page.

Questions patients ask

What is the right age for squint surgery?

There is no single age. Some squints that start in infancy are operated in early childhood; others are treated with spectacles and patching first. Adults can have squint surgery at any age.

Is squint surgery safe?

It is a common operation, but like any surgery it has risks, including under- or over-correction, temporary double vision, infection and the risks of anaesthesia. The surgeon explains them for your eyes before you decide.

Will my child still need glasses after squint surgery?

Often, yes. Surgery straightens the eyes but does not change the spectacle power or cure a lazy eye, so spectacles and patching usually continue as advised.

Can a squint come back after surgery?

Sometimes. The alignment can change over the years, and some people need a second operation. Wearing spectacles as advised and keeping follow-up visits help.

Can adults have squint surgery?

Yes, at any age. It can improve alignment and relieve double vision. A squint or double vision that appears suddenly in an adult needs a prompt examination first, to find the cause.

This page is general eye-health information, not personal medical advice. Your eye doctor advises you after examining your eyes.