Mast. Ritwik*, a 4 years old boy came to Advanced Eye Hospital with a history of squinting of eyes since 2 years of age. He had not had any illness prior to the onset of squinting. Upon enquiry, it was found that squint did run in his family. Ritwik was the first child born of a non consanguinous marriage (His parents were not biologically related as second cousins etc). Ritwik weighed 2 kgs at birth, had a fairly normal birth and his developmental milestones like talking, walking etc. had been within the normal range.

He had already been advised to undergo alternate eye patching for 2 hours/ day since the last six months. On examination, Dr Prachi Agashe, Pediatric Ophthalmologist and Squint Specialist at Advanced Eye Hospital found that his best corrected visual acuity (sharpness of vision) was 6/6 N6 (normal for distance as well as near vision) in either eye. Cycloplegic Refraction (a procedure used to determine a person's refractive error by temporarily paralyzing the muscles that aid in focusing the eye) revealed no significant refractive error.

However, Orthoptic evaluation (evaluation of the balance of the eye muscles) for squint revealed that he had alternate esotropia (convergent squint). Further, Binocular vision testing revealed alternate suppression (He was not able to use both his eye together).

In view of the above findings, Dr Agashe advised that Rutwik undergo surgical correction of squint. Accordingly, the medial rectus muscle of Rutwik’s either eye was recessed (removed from its original position and repositioned) with one muscle on an adjustable suture.  This is one of the latest advances in squint surgery which allows fine tuning of the surgical results in the first 24 - 48 hours.

 

  

                                         BEFORE SURGERY                                                                      AFTER SURGERY  

 

At one week after surgery, Rutwik’s eye muscles were normally balanced and he had already gained binocular single vision for near and distance.

 

Discussion:

• Binocular Vision is the ability to maintain visual focus on an object with both eyes, creating a single visual image. Lack of binocular vision causes distortions in depth perception.
• Squint affects binocular vision as both the eyes do not look at the same object at the same time. Squint or crossed eyes is a disorder in which the two eyes are not aligned properly. Squint surgery is a procedure that is used to change the alignment of the eyes relative to each other by strengthening or weakening eye muscles. 

 

*Name changed