Treatment & Complications

Aims and types of treatment and potential complications.

Video Transcript:

  1. To treat any refractive error
    Most children will need to wear their glasses full time until the age of 8-9. Whether they need to continue wearing their glasses after this age will depend on the size of their refractive error and how good their vision is without glasses.

    If a child with a fully accommodative esotropia has less than 3 dioptres of long sightedness it may be possible to gradually reduce the strength of their glasses without their eyes drifting inwards again, when they are 8-9 years of age.

    It may be possible to wean the child out of their glasses altogether, but more frequently their esotropia returns when the strength of their glasses is reduced.
  2. To treat any amblyopia
    Any amblyopia is treated with 3 months of full time spectacle wear and then occlusion therapy, if the vision has not equalized with glasses alone.
  3. To restore stereopsis if possible
    Unfortunately many children will have had a squint for a number of months before they are seen by an ophthalmologist and will have already developed an amblyopic eye, with reduced or absent stereopsis. In these children treatment of their amblyopia and straightening their eyes with prisms or squint surgery, rarely restores their stereopsis.

    However, if the squint is of recent onset and there is little or no amblyopia, early surgery to straighten the eyes has a good chance of restoring their stereopsis.

    Children with convergence excess esotropia have potentially got excellent stereopsis if their eyes are straightened with either bifocal glasses or surgery.

    In order to decide if a child has any form of binocular potential some ophthalmologists will prescribe prisms, that are stuck onto the glasses, in order to straighten the eyes. The strength of the prism is adjusted at each clinic visit to keep the eyes in a straight position. This process, known as Prism Adaptation, is frequently used by American ophthalmologists prior to carrying out surgery.
  4. To improve the appearance of the squint
    If a child’s squint is still noticeable with their glasses on, then surgery to improve the appearance of the eyes can be considered. Surgery is normally carried out after any amblyopia has been treated, but occasionally surgery will be performed when occlusion therapy is still on going. Typically this is between the ages of 4-6 years of age.

    The aim of surgery is to reduce the angle of the squint that is present when the child is wearing their glasses, so it is no longer noticeable. This may mean that after surgery some children will still appear to have a convergent squint, when they are not wearing their glasses. Parents often ask why surgery is not done to fully correct the larger angle of squint that is present when their child is not wearing their glasses? The reason why this is not routinely done is because most children who have more than 2.5 dioptres of long sightedness will still need to wear their glasses following their surgery and fully correcting their squint will result in their eyes moving outwards into a divergent position when they wear their glasses.

What does surgery involve?

Surgery normally involves weakening the inner muscle and strengthening the outer muscle of the in turned eye, or weakening the inner muscles of both eyes. If an upshot of one or both eyes is present this can be treated by weakening the inferior oblique muscle(s) at the same time.

What are the possible complications of surgery?

The most common complications of surgery are either an over or under correction of the squint.

Over corrections are more likely to occur in children who are very longsighted and in children who still have poor vision in their amblyopic eye. If the outward drift is relatively small, reducing the strength of the long sighted glasses may help correct it.

If the divergent squint is cosmetically noticeable, further surgery may be needed.

Small under corrections are not uncommon. These may be improved by increasing the strength of the child's longsighted glasses.

If the child still has a noticeable convergent squint following surgery, or if their eyes turn in again some years later, further surgery may be needed.

Following surgery the child will need to be seen regularly in the clinic to have their vision and spectacles checked. If the child shows signs of developing a lazy eye again, further patching treatment may be needed.