Strabismus, Squint and The Journey of Eye Patching

This post has been on my mind for a long while - for the past months while we try to do something about E's strabismus.  And to those who do know or who do not know about this, I hope this post clears up some of the questions you might have.  

Let me start from the beginning.  A teacher from E's childcare and another friend told us to bring him to see an eye doctor as they felt that he seems to be having lazy eyes.  Lazy eyes is a very common term used by people - but it is also a very common misused term.  Lazy eyes is not to be mixed up with strabismus, also commonly known as squint.

We first met E's paediatric eye doctor end last year and I told her of my concern and some others' concerns about him having an inward (convergent) squint or lazy eyes.  After doing some checks, she was able to tell that E does not have a convergent squint (like what you see in the below photo).  This, she says is a pseudo squint.  Many Asians babies, particularly Chinese, appear to have an convergent squint as a result of a prominent skin fold that covers the inner part of the eye.  No treatment is required.  However, layman like us will not be able to tell (definitely not me), thus it is best to seek professional help. 

Had a hard time trying to find a photo that best suits what I am trying to say.  I think this does.

Going to a professional is indeed different and I cannot stress how important it is once one feels something amiss.  Paediatric ophthalmologist or eye doctors are able to tell through visual examinations whether there could be something wrong.  As children tend to get bored easily and fidget often, it is best to leave the examinations to professionals in such fields as most often, they are able to tell you lots of information from what they gather within that few minutes frame.

Toys make children more at ease.  Hopefully it calms them down before seeing the doctor and entertains them in between the tests and checks.

Why did I say the above paragraph?  Within the 10-20 minute examinations, apart from the doctor being able to tell me that E has no inward squint, she believed she saw an outward squint and it was an intermediate outward squint.  Seriously, I do not know of such a thing till that very day.

There is always entertainment in a paediatric eye clinic

What is Strabismus or Squint?
Strabismus or squint occurs when the two eyes are not looking in the same direction, i.e. one eye looks straight and the other eye appears to look away.  This can happen at any age.  The squinting eye can turn inwards (convergent squint) or outwards (divergent squint).  A squint can also be vertical, with one eye higher than the other.  

Squints can be constant, i.e. present all the time or they can be intermittent and occur under certain circumstances.

It is important to treat a squint because if left untreated, the brain will eventually suppress or ignore the image of the weaker eye, resulting in lazy eye.  Longstanding eye misalignment may also result in decreased binocular or stereo vision.  

Photo Credit : KKH website

E went through more thorough checks.  Vision tests are a must every visit.   Akin to the vision tests we take at optical shops or even simply reading the letters or numbers on the visual charts from far, vision testing for children is performed by reading a series of letters or numbers of diminishing size on a monitor.  If the child is unable to recognise letters or numbers, a simpler matching test is used instead.  This test is to measure how well one can see in a distance.

And then there were other checks.  Finally a time when E sat on his own.  Most of the times, he sits on my lap.  Checks carried out with both near and far objects.  At a paediatric eye clinic, the objects are often toys and kids' movies to attract their attention.

Dilating eyedrops are sometimes used in children to obtain accurate refraction.  These eyedrops also dilate the pupils in order to allow the doctors to perform a full eye examination.  

The eyedrops are administered at two or three intervals depending on the degree the pupil dilated.  The child's vision may be blurred for up to a day after the dilation and the effects are only temporary.  It is very important to remember to always hold the child and not let him run around as accidents may happen with a blurred vision.

Of course, it is uncomfortable.  Stickers will be given, I will bring snacks and offer bribes.  Because of the time intervals, we will walk around the area, not in the sun as he becomes very sensitive to bright lights.

The past few visits and tests confirm his intermediate outward squint.  It is an outward deviation of an eye that happens some of the time.  For E, his eye tends to turn outwards when he is focusing far, such as watching a show from a distance.  That is why none of us noticed it.  It is not easy to catch.  And I am glad the eye doctor caught it in time for us to treat it.  It is always a good thing after each visit to hear that there is improvement or even status quo - anything that seems otherwise is unpleasant.  So if you ask me, always bring the child in for a check if you notice something not quite right.  It does not hurt to be more kiasu in this instance.

Eye patching has become a norm for E.  He has to patch his good eye for about 2 hours a day so that the weaker eye is forced to do the "seeing" work and over time, strengthen the vision in the weaker eye.  It may also at the same time help strengthen the muscle of the weaker eye and restore proper alignment.  

It was not easy when we first started eye patching.  He decided to because we told him he was like this Spyclops character from Lego's Ultra Agents.  Sometimes, we have to reward.  Sometimes, we have to use bribes.  But it gets better each time as it soon became a routine.  Till... he knew how to remove it.  And then, a new round of role-playing, rewards and bribes start and the cycle continues.

Photo Credit : Lego.com

We are hoping the day E no longer needs an eye patch will come soon.  With more parents being educated and exposed to such information, we sometimes see children with eye patches going round with their normal activities.  There is no need to feel "paiseh" or embarrassed about it.  Squints are not preventable but with early intervention and timely treatment, it can be cured.

Disclosure:  I am not a medical practitioner.  What is written is from what I have learnt as a parent. 

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