Squint – How I Do It

Paediatric Ophthamology & Strabismus

Abstract

Introduction: Squint is a condition where there  is misalignment of the visual axes[1]. Common types include esotropia and exotropia   while hypertropias are not very common[1]. This article seeks to describe how I carry out squint surgeries secondary to either head  injuries, cerebral palsies (CP), cerebral visual impairment, cataract or any other cause in my practice.

Methods: My first steps involve carrying out general examination of the child’s overall appearance, level of alertness during history taking, noting any head posture, and gross ocular alignment. I also generally assess a child with dysmorphic features. I always  examine the systems such as the cardiovascular, abdominal, chest, musculoskeletal and central nervous systems. For ocular  examination, I usually assess visual acuity using preverbal and verbal techniques as appropriate. I then observe fixation for monofixation or binocularity. In monocular fixation I test for central, steady and maintained fixation or fix and follow gaze. Eccentric fixation is an important sign as this shows that the patient is not fixing with the fovea and vision is in the range of 20/200 or worse. I  examine the child or adult appropriately looking for media opacities, refraction, other tests, stereopsis, etc. I refer children to  paediatricians for systemic evaluation and invite anaesthetists to examine the child to confirm fitness for surgery. Pre- operatively, I  nsist the patients use prophylactic topical antibiotics and maintain good personal and facial hygiene. After proper examination and  preparation for surgery, children are usually done under general anaesthesia while adults are done under local anaesthesia