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Suggest treatment for squint eye

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Posted on Mon, 22 Dec 2014
Question: Dear Doctor

My friend who is currently in US needs advice regarding treatment of squint for his 3 year old daughter. Can you please help us by reviewing the attached case details and provide your valuable advice? Since the family is in US temporarily, they are very worried about situation and desperately need medical advice from renowned expert like you.

We will be highly obliged if you can please help.

Thanks in advance.

Regards
doctor
Answered by Dr. Dadapeer K (33 minutes later)
Brief Answer:
The treatment for squint is in right direction.

Detailed Answer:
Hello
Welcome to Health care Magic.

I am Dr. DADAPEER K, an Ophthalmologist and I will be answering your question.

I reviewed your history and the detailed reports attached with the question.

It seems from the history that 3 year old girl is having problem of squint in the form of esotropia.

I can understand your concern and first and foremost I would like to say no need to worry as squint in this age group is a common problem and it is a treatable condition and with appropriate treatment it can be cured. Hence no need to worry.

Squint more commonly medial deviation of the eyes called as esotropia is a common problem in childhood.
Esotropia in children is of two broad types, Refractive and Non refractive esotropia.

Refractive esotropia is one which is associated with underlying refractive error and this will be corrected with use of spectacles.
Non refractive esotropia is usually not corrected by spectacles and may require surgery.

The first thing to be done is to assess the underlying refractive error and correction for the same if present.
It is a good thing that she is wearing spectacles and vision is showing improvement with spectacles.
But since the vision in both the eyes is not equal this requires occlusion of the eye with better vision and stimulation of the eye with lesser vision. Since it is also being done no need to worry, the treatment is in right direction.

Now the next step depends on
Whether the squint is corrected by wearing spectacles or not and response to occlusion therapy.

Since in this case squint is not getting corrected completely by wearing spectacles, the next mode of treatment in the form of surgery or Botox injection has to be planned.
This needs to be done after initiating the occlusion therapy and once the child is wearing glasses regularly.

Hence next step in treatment here is surgery or Botox injections. But the timing needs to be decided. As she is appearing to be responding to spectacles and occlusion therapy, this needs to be continued for 3-4 weeks and once she can hold the eye with improvement in the vision she can be taken for either Botox injection or surgery.
Even after surgery or Botox injection also, the occlusion therapy needs to be continued.

Hence I advice you to follow up with your doctor after 3-4 weeks as advised and do discuss with your doctor regarding the improvement and further course of treatment accordingly.

Hope this information is helpful to you.

Do write back to me for further questions.

Thank you
With regards


Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Dadapeer K (7 hours later)
Thanks Doctor. Some follow up questions:
1. How long should we try occlusion before deciding to go for next step? Some one mentioned to me that it has to be continuously done for 6-9 months. We have done for only 6 weeks at 2 hourly basis till now.

2. You mentioned that occlusion has to be done even after surgery. Can you please clarify this a little more?

3. Between botox and surgery, which is better option to go for?

Regards
doctor
Answered by Dr. Dadapeer K (31 minutes later)
Brief Answer:
Botox is better option compared to surgery.

Detailed Answer:
Hello
Thank you for the follow up questions.

The answers for your questions are as follows.

1. Occlusion treatment is basically done to improve vision in the eye with lesser vision and hence to prevent development of lazy eye or ambylopia.
Hence it is done in all cases where the vision is different in two eyes irrespective of presence of squint. Hence squint surgery or any other mode of treatment can be any done any time without depending on the duration or result of occlusion treatment.

2. Occlusion needs to be done till vision in both the eyes is equal. Hence till the vision improves and becomes equal in both the eyes it has to be done.

3. Between Botox and surgery, surgery is the standard one but we prefer to go with Botox as it is less invasive compared to surgery and can be done easily. Hence I personally prefer to go with Botox and results are almost similar to surgery in most of the cases.

Hope this is helpful to you.

Do write back to me for further questions.

Thank you
Above answer was peer-reviewed by : Dr. Shanthi.E
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Answered by
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Dr. Dadapeer K

Ophthalmologist

Practicing since :2003

Answered : 5709 Questions

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Suggest treatment for squint eye

Brief Answer: The treatment for squint is in right direction. Detailed Answer: Hello Welcome to Health care Magic. I am Dr. DADAPEER K, an Ophthalmologist and I will be answering your question. I reviewed your history and the detailed reports attached with the question. It seems from the history that 3 year old girl is having problem of squint in the form of esotropia. I can understand your concern and first and foremost I would like to say no need to worry as squint in this age group is a common problem and it is a treatable condition and with appropriate treatment it can be cured. Hence no need to worry. Squint more commonly medial deviation of the eyes called as esotropia is a common problem in childhood. Esotropia in children is of two broad types, Refractive and Non refractive esotropia. Refractive esotropia is one which is associated with underlying refractive error and this will be corrected with use of spectacles. Non refractive esotropia is usually not corrected by spectacles and may require surgery. The first thing to be done is to assess the underlying refractive error and correction for the same if present. It is a good thing that she is wearing spectacles and vision is showing improvement with spectacles. But since the vision in both the eyes is not equal this requires occlusion of the eye with better vision and stimulation of the eye with lesser vision. Since it is also being done no need to worry, the treatment is in right direction. Now the next step depends on Whether the squint is corrected by wearing spectacles or not and response to occlusion therapy. Since in this case squint is not getting corrected completely by wearing spectacles, the next mode of treatment in the form of surgery or Botox injection has to be planned. This needs to be done after initiating the occlusion therapy and once the child is wearing glasses regularly. Hence next step in treatment here is surgery or Botox injections. But the timing needs to be decided. As she is appearing to be responding to spectacles and occlusion therapy, this needs to be continued for 3-4 weeks and once she can hold the eye with improvement in the vision she can be taken for either Botox injection or surgery. Even after surgery or Botox injection also, the occlusion therapy needs to be continued. Hence I advice you to follow up with your doctor after 3-4 weeks as advised and do discuss with your doctor regarding the improvement and further course of treatment accordingly. Hope this information is helpful to you. Do write back to me for further questions. Thank you With regards