Convergent Squint advice

[MNTotoro]

DD (3) has a convergent squint. The orthoptist thinks her vision is not impaired, but she has referred us to consultant orthoptist for a check (the one with the drops).

It has developed in the last 6 months (ie not there when tiny baby) and seems to be worsening. The fact that it doesnt seem to be affecting her vision at all was a surprise.

Her appointment is at the end of August. What are they likely to tell me? I got the impression that they may not want to patch given that her vision is not affected and that surgery might be the eventual outcome.

I dont want to second guess but I am feeling anxious.

As this age and with the history you've given the tests that need to be done will include a glasses check (almost certianly using a cycloplegic drop).

Often, a convergent strabismus (squint) is related to a degree of long sightedness.

Sometimes, wearing a pair of glasses is enought to correct the turn.

If it is not, then you're likely to be monitored until your child is old enough to ensure the best cosmetic outcome of an operation.

If the vision in either eye drops the patching will be used to bring it back up.

Some children are put forward for earlier surgery but often better results are obtained with delay.

Does that make sense?

Yes, makes sense. My other DD has an astigmatism in one eye and a divergent squint in the other so am a little familiar with terms.

Are you saying they may use glasses/patch the eye to fix the squint, but that might detrimentally affect her vision, and then they'd need to fix that as well?

No, I'm not saying that.

The patch can be used to restore the vision in an eye that has deteriorated relative to it's fellow from not being used.
This may happen if one eye is consistantly turning.

Glasses may help with the turn if your child is longsighted or has substantial astigmatism.

Glasses used in this way are likely to improve vision as well.

Is that any clearer?

Thanks DBennett. Makes sense. I guess I am thoroughly confused how DD can have such an obvious (and increasingly common) squint and yet they think it isnt affecting her vision at all.

I know i need to wait until they do the proper eye check with the drops and torch and stuff, but end August seems like an age to wait

They asked me if she'd been ill at all in the last 6 months, inferring that serious childhood illnesses can be a cause of a sudden occurance of a squint. She hasnt been ill but I guess my mind is working overtime.

I say she hasnt been ill, but she does seem to pick up every bug going and had hugely swollen glands in about Feb time, which the GP was concerned about. No measles or mumps or anything though...

A turn is only damaging to the visual system if one eye is being used exclusively.

This will leave the brain to ignore the other eye.

If this is not happening, either because the turn isn't there all the time, the turn switches sides, or your child cross-fixates (when they use one eye for one side of the room and the other eye for the other, sounds odd but it can happen) then the vision will likely be uneffected.

I know that august seems like a long time but there is pretty good evidence that harm occurs very slowly so even if it is occuring (something which is unknown at this point) the delay will likely make no difference to the outcome.

Thank you DBennett. I feel a bit reassured. Think I might be a bit hormonal today

No bother.

Hope the appt goes well.

This squint is now affecting her vision and the eye is weakening so she is being patched. Last check showed it wasnt making any difference. How long does a child need to be patched for any noticible difference?

Oops. should mention that I am MNTotoro. :)

Hi Eustacia, my DD also has convergent squint when she focuses. She wears glasses which control the squint very well, despite it being very noticeable when she doesn't wear them. Orthoptists have said it's a micro-squint so not worth surgery at this stage, so she will probably have to wear glasses or lenses into adulthood. The squint arose just after a bout of mild chickenpox, and I was told by the orthoptist that anecdotally there does seem to be a link.

DDs vision was found to be slightly below par for her age at one point, so she was only patched for 30 mins per day for one month and we were encouraged to do close work (ie reading, colouring) during the patching session. Just this small amount of patching brought her vision level back up to 20/20 for her age.

How long is your DD being patched for - can you ask whether increasing the duration each day will improve the effect?

dd wore her patch for 2 hours a day for many many months. It then dropped to 1 hour a day for a bit longer and once her sight in her left eye matched her right eye the patching stopped. She did have an eye op at the age of 4 as the squint was still obvious even when she had her glasses on. She is long sighted and has worn glasses from the age of 18 months (now 7 1/2 years)

Thanks. She is currently wearing her patch for 4 hours a day so I guess that means it's pretty bad? She's been waring the patches for about 4 months and, as I said, it appears to be having not much effect at the moment :(

It is good to hear of other experiences though, so thank you.

The vast majority of the improvement gained by patching happens in the first 200hrs.
You don't tend to get much benefit after that.

But that improvement is skewed towards the latter end so there is often a delay before improvement and then quite a substantial improvement a bit later.

Stick with it is my advice.

Thanks DBennett. We have our next orthoptist appointment a week on Monday so I'll see what they say.

Well, I think it was a good appointment.

The orthoptist said that the patch has evened out the eyes a bit although she is now squinting with the other eye which they dont want. So we have now been told not to wear the patches any more, and she is having a sight check (for new glasses) in 4 weeks. They then said that they we will re-assess when she has been wearing her new glasses for 6 weeks.

For the first time they confirmed that Dds eye wandering inwards was more of a cosmetic issue and may need to be dealt with seperately (surgically?) at a later date ie, after she's 8.

Does that sound logical?

Glad the vision is better.

It is a good idea to hold off on a cosmetic eye turn operation as a lot of the time you find the measurements and look changes as the child gets older.

Sounds like things are going better.

Thanks DBennett. It is good to have another opinion.

Eating lots of blueberries and drinking carrot juice (kubus applle/banana/carrot mix is very nice) does improve eyesight.
Squint needs to be sorted before 6 years old? I am not sure when exactly but when you squint your eyes can't focus. This can lead to alternate vision. If eyes are repostioned early enough the brain can relearn to focus otherwise you are left with an alternate vision. As far as I am concerned I look normal but I can't see in 3D and I have always been unable to play any ball game except basketball where the ball is so big and orange! I also blame my poor parking ability onto alternate vision!
My advice sort it out early!

Thanks tulipe. The chances of me getting carrot juice down DD are slim, :) but it is interesting to understand how the squint makes you not see properly. I find it difficult to get my head around how she must actually be seeing things iyswim.