Squints and Squint Surgery in Children

  • Reference Number: HEY-729/2015
  • Departments: Orthoptic

Introduction

This leaflet has been produced to give you general information about your child’s condition. Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and your child’s doctor, but may act as a starting point for discussion.  If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for your child.

What is a squint?

A squint is the common name for ‘strabismus’, which is the medical term to describe eyes that are not pointing in the same direction. Squints are sometimes called ‘lazy eye.’ Squints occur in between 3 – 5: 100 of all children. They can occur at any age but most develop in childhood.

The squint may be present all or only some of the time. It may be in one eye only, both eyes or may alternate between the two eyes.  When your child is diagnosed with a squint, glasses or patching may be necessary. Sometimes surgery may also be needed.

What is Squint Surgery?

Squint surgery involves adjusting the position of the eyes by moving the muscles on the outside of the eyeball (this does not involve removing the eye). Usually two muscles are adjusted, one muscle is strengthened and the other is weakened. The surgeon may choose to operate on one eye or both eyes to achieve the best outcome. Your child’s surgeon will discuss this with you at the time of consent.

Why does my child need squint surgery?

Surgery may be necessary to:

  • Make the eyes look straighter (termed a rehabilitative case)
  • To enable the eyes to work as a pair (termed a functional case)

The ophthalmologist (eye doctor) and orthoptist will discuss this with you at the time of listing your child for surgery if you choose to go ahead with the procedure.

You should be clear in your mind as to the expected aim of the surgery after your discussion with your child’s ophthalmologist.  Surgery may or may not be the only option available to your child; this will be discussed with you by your child’s healthcare team.

Does it matter if the squint is not treated?

Not all squints need an operation but a squint should always be assessed. If your child has a true squint they will not grow out of it.  Dependent on the type of squint you may notice it less as your child gets older but it will always be there. Some squints can cause secondary effects such as stopping visual development. Though this is not the case for all children however a significant proportion may need treatment and monitoring for this. If certain intermittent squints are not treated they may become constant. Your orthoptist may ask you to consider surgery if this is the case and will arrange for your child to see his or her consultant.

Whether the squint is operated on or not your child will still need to wear their glasses if they needed them before the surgery. Squint surgery carried out to straighten the eye for cosmetic reasons, which is known as cosmesis, will not improve the vision in that eye.

Can there be any complications or risks?

Squint surgery is very safe and complications are rare. If complications do occur they can in most cases be treated effectively.

General Anaesthetic – The operation is performed under general anaesthetic and providing your child is healthy, the risk of things going wrong due to the anaesthetic is small. Adverse reaction to the anaesthetic occurs in 1: 20,000.

Double Vision – There is a very small risk of double vision after the operation. Normally this settles on its own. If not, the orthoptist will decide whether changing your child’s glasses, eye exercises or further surgery is needed.

Cosmesis – There is a risk the squint may be over or under corrected and sometimes further surgery is needed (approximately 20: 100 of cases).

Infection – There is a very small risk of infection in the eye (1: 30,000).

Allergy – Some patients might have a mild reaction to drops prescribed after surgery. This results in itching / irritation and some redness and puffiness of the eyelids. It usually settles very quickly when the drops are stopped.

Redness and scarring – Your child’s eye will be red after the surgery. The redness and any scarring will not be noticeable three months after surgery. Occasionally, the white part of the eye does not completely return to its normal colour and mild visible scars may remain, particularly in cases of repeated operations.

Lost or slipped muscle – Rarely one of the eye muscles might slip back from its new position during the operation or shortly afterwards. If this occurs, the eye is less able to move around and, if severe, further surgery may be required. The risk of slipped muscle requiring further surgery is about 1: 1,000.

How do I prepare my child for the squint operation?

Your consultant will discuss with you whether surgery is necessary in your child’s case.  When you see the consultant, if you are in agreement, then your child may be offered a date for the surgery; however it is more usual for your child to be placed on a waiting list.

We will ask you to inform us at the earliest opportunity of any holiday arrangements that you may have already or any that you make at a later date whilst your child is on the waiting list. We would also ask you to ensure we have your current telephone number and inform us of any change to this or your address.

You will usually be given about 2 weeks’ notice of the date of your child’s surgery. You need to know that there are a number of appointments we will need you to attend before and after the surgery date. These include:

Pre-operative assessment

Usually 1 week before the surgery date. You will see the orthoptist and the doctor. Details of the surgery will be confirmed at this visit. You will visit the ward where your child will have a general health check and you will have an opportunity to visit the ward where your child will be staying on the day of the surgery.

Date of the operation

You will receive detailed instructions when you attend for your pre-operative visit. Generally your child should not eat or drink at least 6 hours before the operation. You will need to arrive at the hospital early. The operation will be carried out in the morning and your child should be able to go home in the late afternoon, as long as they are feeling well. If they are not feeling well, they may need to stay at the hospital overnight. Please bring any special toys or comforters that may help your child settle. It is advised that you arrange for someone to collect you and your child from the hospital rather than use public transport.

What will happen?

  • On the day of the surgery you will need to arrive at the hospital early, you will be advised of a suitable time
  • You will have an opportunity to speak with the your child’s consultant
  • Your child will be undergoing general anesthesia which means they will be asleep during the operation. If you wish, you will be able to accompany your child to the operating theatre until the anesthetic is given
  • The operation will last approximately between 40 minutes to1 hour
  • When your child returns from the theatre, the eye that has been operated on may be covered. This is in place to prevent accidental rubbing of the eye and may be removed when your child wakes.
  • The eye may be red, feel sore and be weeping. This is all normal. If your child does complain of pain or soreness the nurse will be able to provide pain relief.
  • Before your child goes home, you will be shown how to effectively bathe the eye and how to put drops into your child’s eye.
  • You will be given the number of the ward for you to contact if there are any problems once your child has been sent home after surgery.

What happens afterwards?

  • When you are at home it is important that you follow the instructions that you were given to bathe your child’s eye. You must also instill drops into your child’s eye as instructed to prevent the eye from becoming infected.
  • Your child will need to avoid rough sports and swimming for at least 4 weeks following the operation. It is also important your child avoids dirty, dusty environments for at least 2 weeks after the operation or until the eye has had chance to heal properly
  • It important to plan that your child will need to be off school for up to 2 weeks after the operation date and you will need to put drops in your child’s eyes 4- 6 times a day for approximately 1 week following the surgery.
  • Your child will need to attend two post-operative appointments
    • First post-operative assessment. Your child will need to attend the orthoptic department 2-3 days after the operation
    • Second post-operative assessment. Your child will have an appointment to see the orthoptist and the ophthalmologist 2-3 weeks after the operation

These appointments will be arranged for you and given to you by the staff nurse looking after your child.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Orthoptic Department on telephone no: (01482) 816605

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats your child, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to your child. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your child’s condition, the alternatives available for your child, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about your child

We collect and use your child’s information to provide your child with care and treatment. As part of your child’s care, information about your child will be shared between members of a healthcare team, some of whom you may not meet. Your child’s information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide your child with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your child’s doctor, or the person caring for your child.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about your child. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.