Non-surgical treatment for squint

The aims of treatment for a squint in childhood are to make sure that the vision in each eye develops normally (i.e. prevent amblyopia), and to help the two eyes work together so that binocular and 3D vision can develop as much as possible too. In order for treatment to be successful, it needs to be given before the visual pathway finishes developing (before the age of 7-8).

Most treatment for squints is on-going and it usually involves regular visits and examinations at the hospital eye clinic for a number of years. How often your child needs to be seen by the eye clinic will depend on factors such as their age, the type of squint they have, and how well a treatment is working.

Often more than one treatment or a combination of treatments may be needed to get the best result for your child’s vision.

Some of the most common ways that squint non surgically are:

  • Glasses
  • Occlusion therapy (patching)
  • Exercises

1) Glasses

Usually the first step in dealing with a squint is for your child to be tested to see if they need glasses. It’s important for your child to have properly prescribed glasses to give them clear vision in both eyes. This can help to prevent the squinting eye from becoming amblyopic or lazy. Most children with a squint will be prescribed with a pair of glasses that they will need to wear all the time.

You may notice when your child wears their glasses that their squint becomes less noticeable or disappears completely. When your child takes their glasses off you will notice that their squint can be seen again. This means that the glasses need to be worn to correct the squint. Many children may only need to wear glasses to treat their squint.

It’s not unusual for your child to say that they can see better without them at first. This is because they have been working their eyes so hard to focus without glasses that they find it difficult for their eye to “relax” into the glasses and let the glasses do the focusing for them. This usually settles once your child is wearing their glasses all the time.

Most children with squint who need glasses need to wear them all the time.

2) Occlusion therapy (patching)

Occlusion therapy can’t straighten the eye, but is used to improve the level of vision in an amblyopic or lazy eye. Patching involves covering your child’s good eye with a patch. Your child then uses their weaker eye to see and this helps to build up the pathway between this eye and the brain. In effect, the visual development of the weaker eye gets a chance to catch up. If patching is done early enough in childhood, the vision can improve often up to a normal level.

If your child wears glasses, patching should always take place when glasses are worn, usually with the patch worn underneath their glasses, so that they can’t “peep” around the patch. How often and for how long and when will be the best time for your child to wear their patch can vary. When your child is wearing their patch, it’s important to encourage them to use their lazy eye by reading, colouring, watching television or playing computer games.

It can take several weeks or months for eye patching to be successful and treatment is usually continued until the vision is normal, or no further improvement in vision is found.

Sometimes when patching is successful and has been stopped there is a chance that your child’s sight may worsen slightly again and hence the patching duration should be tapered gradually.

Sometimes eye drops are used as an alternative to a patch. Atropine drops blur the vision in your child’s good eye enough so that they will start to use the other eye, just like when wearing a patch

3) Exercises

In some types of squint, exercises can be useful to strengthen the ability of the eyes to work together. This type of treatment is usually helpful in older children with intermittent squints, convergence insufficiency and is normally used together with glasses and/or surgery.