Seeing Straight
If both eyes do not point in the same direction, you're
probably squint. Inward-turning eyes, called a convergent squint
or "cross eyes", usually occur in young children. A divergent
squint, when the eyes turn outwards is less common. Although not
necessarily painful, a squint can be a distressing condition.
Many adults are concerned about their cosmetic appearance, and
nearly four in every 100 adults suffer from some form of squint.
They may wish to correct this from a cosmetic angle, but there
is also the physical disability that often accompanies this
condition; loss of eye-hand coordination; bumping into things
when ascending, or descending stairs or kerbs; crossing the
street, driving, and playing sports.
Many adults who suffer from squint problems are not aware
that help is at hand. The good news is that adults need not
suffer. Recently there has been an increase in effective,
available treatment.
The principal treatments used are Botulinum Toxin and/or eye
muscle surgery. Botox has become 'the injection du jour' as
more and more people follow in the footsteps of celebrities to
smooth out their wrinkles. However, few people realize that the
medical use of Botox was originally for the treatment of eyes
that were squint. Today, a simple injection can rectify many
unsightly turns of the eyes. This is an outpatient procedure
that requires only a few drops of anaesthesia, and takes about
30 seconds. "Botox treatment has made a real difference for many
patients. Not only does it help to realign the eyes, it can
increase confidence and social skills. It's not just a cosmetic
thing, it can affect your job prospects," says Mr Christopher
Bentley, a consultant ophthalmologist.
But is Botox safe? According to the surgeons who carry
out these 'squint' treatments, Botox has become the treatment of
choice for muscular spasms affecting the face; and repeated
studies have demonstrated that it is effective and safe. The
target muscle is injected with a very fine needle. Benefits
begin in one to 14 days after the treatment, and can last on
average about three to four months, after which you can go for a
top up. All effects of the toxin ultimately reverse with time. A
range of studies have confirmed the side effects to be minor in
the vast majority of applications, and they are definitely dose
related. The Botulinum Toxin administered in the case of squint
treatments is heavily diluted. Some of the reported side
effects have included flu-like symptoms, pain at the site of
injection, headaches, and muscle weakness, but these are usually
mild and transient. In addition, adjustable stitches are used
for squint surgery in adults. The operation is usually done
under general anaesthesia and some stitches are not permanently
tied. If the squint is still present after surgery, local
anaesthetic drops are given and the stitches adjusted until the
eyes are in the correct position. "This is a relatively new
development and a really helpful tool to help the surgeon to
fine tune surgery," says Bentley.
The type and amount of surgery to perform for a particular
squint demands an accurate preoperative decision and
necessitates meticulous surgical planning and accurate
prediction of surgical outcome. "The surgical aims are
realignment of the eye muscles where necessary to achieve
satisfactory function and appearance," says Bentley.