Assessment of Squint (Eye Examination)
Posted by: drhaisook on: March 1, 2007
Many students – including me – are a little confused when it comes to assessment of eye squint (strabismus) cases. The fact that there are latent squint cases rather than the easily noticed manifest type gives some students headache on exam nights.
Note
- Eye faces inwards (nasally) is called esotropia
- Eye faces outwards is called exotropia
Now that my clinical opthalmology exam is qutie close, I thought I’d sum up the tests need to assess such cases. Imagine you’re on your exam day, and you meet a patient whose squint case/status needs to be assessed.
You greet the patient, and notice his/her eyes. Sometimes the squint is quite obvious (Manifest squint), and sometimes it’s not (either weak Manifest squint, or Latent squint). See below for more details.
Primary Fix Test By Light Torch
If you can’t tell for sure if there’s squint, make the patient fixate his sight to the center (not necessarily his eyes as there might be a Manifest squint preventing him/her from that i.e. at least the normal eye should be directed to the center). You may hold your light torch one foot infront of the patient’s nose, and ask him/her to look at it. Then, with your torch light centered on the face, notice the tiny dot of light on the eyes. On each eye, it should be situated exactly on the center of the pupil. Any deviation, either to left or right, points to a case of squint. (see image below).
IMAGE WILL BE UPDATED SOON.
Notice where the tiny dot of light resides on the right eye. It’s between the pupil and the edge of the iris (limbus). While on the left eye, it’s situated in the normal position; the center of the pupil.
Now that you determined if there was a squint or not, there are a couple of tests available for particular reasons.
If…
- First case:
Squint is determined by light torch
You need to know if it’s in one eye or alternatively in the other one, too… that is Alternative squint.
- Second case:
Squint is not determined by light torch
You need to know if there’s some kind of a Latent (hidden) squint or not.
For these, you’d need to do the Cover/Uncover test.
Cover/Uncover Test
In either of the abovementioned cases, make the patient fixate his sight to the center (as detailed above).
Now with your hand or preferably a properly-size hard card, cover the normal (non-squinting) eye in the case of a Manifest squint, or any of the eyes in a normal case where no squint has been determined by a torch light.
In the first case, while you’re covering the normal eye, notice the squinting eye. Does it move to the normal position or not. Then, quickly uncover the normal eye, and observe if it had moved inwards or outwards while under the cover. If it did, then this would be an alternative squint. If not (i.e. the normal eye never moves in any case), then it’s a unilateral squint.
In the second case, after covering any of the eyes, switch slowly to the other eye, and notice where the firstly covered eye position had been. If it had moved inwards or outwards, this would be Latent squint. Repeat the process with the other eye, if the same happened, then it would be Latent Alternative squint.
P.S. The idea of covering/uncovering is that you cut off the brain’s (nervous) activity in the covered eye, so squint – being caused by musclar defects – shows up. In most of the cases, the uncovered eye is/moves to the normal position, so always concentrate on observing the covered eye while covered or quickly after uncovering.
Hope this helps!
Courtesy to Rishi Prasad, and M. Afify for the images and the info.
Collected and organized by me.
30 Responses to "Assessment of Squint (Eye Examination)"
March 14, 2007 at 1:46 am
Hi Mouauia Naeif,
Welcome to my medical website, but I’m afraid no personal contact info is allowed here. So I had to remove those telephone numbers.
May 4, 2007 at 8:34 am
Hello Doctor,
My Kid(5 months old, male) looks like having a intermitted squint on left eye. He looks normal, sometimes suddenly when he tries to see some toy or object that time his eye is moving extra towards nose. My doubt is 5 months is too early to check this. Can I wait some more months to consult a doctor. What kind of treatment is best for my infant. YOur reply would be very helpful. Thanks.
With Regards,
Ajeeth
May 4, 2007 at 4:19 pm
Hi Ajeeth,
You should consult a doctor (ophthalmologist) as soon as possible. If your son has squint, he must be treated as soon as possible to prevent visual defects in the future as correct visual perception is formed in very early childhood.
Good Luck.
July 2, 2007 at 7:53 am
Hello doctor,
I am 29 years old, i have a squint on left, I have been operated 6 years back, but still there is no change. Can this be corrected.
Thanking you and awaiting to receive your early response.
With Best Regards,
Vidya
July 2, 2007 at 5:40 pm
Hi Vidya,
Assessment of your squint case via clinical examination should first be made. The ophthalmologist will then be able to tell if it can be corrected surgically or not.
August 24, 2007 at 11:10 am
Hello Doctor,
My daughter is just 1 year old. During her 3-4 months of age, she has squintted eyes. But later of time, it was not there. But suddenly now she has squintted eyes. Is this problems occurs due to diet or daily day-to-day activities. how to cure/prevent squintted eyes.
Please suggest me.
Thanks
Alags
January 10, 2008 at 4:15 pm
Hello Sir
I am 25 yrs old,I have squinted
in childhood time the squinted is very small
but now there is more deviation,suggese
me,if surgically only corrected or if any
other treatment to clear this squint
Regards
Mohan
January 11, 2008 at 1:16 am
I yelled at my boyfriend in august till something happen to my eye and I cried for him showing me nudity of other women till I could feel some pulling under my bottom eyelashes like eye muscle also prior I had spent countless hours on the computer.This day he upset me I felt something pulling and more white of the eyeball shows of the right eye plus it hurts under the eye sometimes the eyeball hurts plus for some reason my right eyebrow feels sore.That right eye shows more of the eyeball like I had stroke.what u think happen? what can be done to get my eye back like it was before?-shelia p.s. the same day that happen pain hit me in my gums I ended up with gingivitis
March 21, 2008 at 6:38 pm
Sir,
I Am 27 Years old,i am suffering from Squint problem in my left eyes.I stay in mumbai kindly suggest me can it be 100% cured in this age. As per my friends & relatives i have a very minor squint problem.People tease me because of which i really get depressed & i don’t feel like having eye to eye contact to anybody.I don’t feel confident during interviews due to this reason.please help me.
March 21, 2008 at 11:03 pm
Mohan and Sanjana Singh,
Almost every squint can be surgically corrected. Pay a visit to a nearby ophthalmologist.
Shelia,
You need to check with a physician to perform an examination on you.
March 26, 2008 at 1:16 am
Sir,
I’m 20 yr old, i have intermitted squint in my eyes & my eye sight is weak, which is -3, my doctor has told me to go for sugery but there’s an other doctor who had forbidden me not to go for surgery because my nerve is involve, & after few years it is possible that my eye sight could be weaker more & there are chances of my squint to be appear again, i just wanna know that if my eye sight is weak so should i go for the surgery or not! please help me!
May 18, 2008 at 11:59 am
Hello Doctor,
I am a 32 year old woman residing in Mumbai. I am born squint ,though there is no family history of squints.
My parents got me operated when I was six years old. Doctor had suggested for the second surgery at that very time. But my Parents could not get me operated again. And defect still remains. Today I am a married woman . And I want to get this squint corrected.because this causes me a lot of inferior complex in my personal life as well as work place. Please suggest if it this correction is possible now at this age. Also are there any risks involved in this surgery. Please reply.Thanks.
May 25, 2008 at 1:47 pm
Hi Rabie,
Listen to the doctor you trust the most. Usually intermittent squints are not a big problem and do not need surgery. I assume you wear eye glasses which should correct the squint most of the time.
Hi Nilufer,
Yes, mostly any squint can be corrected. Check with an ophthalmologist (Eye doctor).
August 22, 2008 at 8:12 pm
hey im rachel im 13 years old i have a squint in my left eye i have already have operaion but my squint is still noticed most of the time . i get bullied alot at school most people say im not normal im scared i will never have a boyfriend that is willing to be with me forever if it is true that im not normal im upset all of the time worrying what my future holds x please write back rach xox
August 23, 2008 at 11:58 pm
Hi Rachel,
Sorry to hear about your problems. Of course you’re a normal person. Squint is just a small variation. There are great people who have squint, many of them have boyfriends/girlfriends and live happily. Squint does not make you bad. You should check with a doctor (preferably the doctor who had done the operation) if you’re really concerned. He/She is going to assess the problem and tell you what can be done.
Hope this helps.
September 26, 2008 at 3:31 pm
Hi Doctor,
Nice to see ur reply as u have suggested me to visit nearby ophthalmologist.
Can u please mention some of the expert ophthalmologist of mumbai with address so that i can visit them as soon as possible……..please help.
October 8, 2008 at 2:59 am
Sorry sanjana, I don’t live in India and so I can’t help you with that. You should ask people about it, check out the newspapers,…etc
November 26, 2008 at 5:21 pm
sir,i am pavan kumar and i have a squint in my right eye(extropia),i am 21 years old.,i have very poor vision in my right eyeand i have very perfect eye sight in my left eye.should it be safety to go with correction of squint in this age and is there will be any problem in the vision of both eyes in future(like double vision etc.)lease give me a suggestion
December 19, 2008 at 6:39 am
hello doctor,
I am 22 years old gye. I have squint in my left eye. but this eye is completely blind since my child hood. can this be corrected by a surgery?
Thank you.
December 19, 2008 at 8:27 am
There are many important concerns when it comes to surgical treatment of squint. You must visit your ophthalmologist (eye doctor). It could be very well treated.
Good luck.
December 23, 2008 at 1:35 pm
Hi i’m 24 years old staying at mysore, karnatake. I have squint since my childhood. I hav decide to get it operated now, so can you please suggest me whom should i meet and how. Hospital at Bangalore hospital or Mysore is convinient. Pls tell me the operation charges too.
Looking forward for ur reply
December 23, 2008 at 3:53 pm
Asha,
Not residing in your city, I cannot give advice. You must check with an ophthalmologist (eye doctor) first who will examine you and assess the situation.
January 22, 2009 at 2:12 pm
Hello doctor
My age is 26 year old. Doctor say’s in my eye’s have an alternative squint since my childhood.But my eye’s visions are 6×6 & .I have wears the glasses about 0.5 no. in the both’s eye’s. but doctor say’s my eye’s squint is very large . It is not possible to correct the eye’s upto 100% . He say’s it is correct upto only 50 % after one surgery . Please tell me about how many surgery are required to correct the alter native squint upto 100% . I want to know it is possible or not possible & I want to know about any another alternative to correct alternative squint eg. Vision therapy.
I am very thankfull to u If u guide me .
January 25, 2009 at 2:36 pm
kamal, you should trust your doctor. If not, you can ask another specialist.
February 6, 2009 at 10:08 am
my son is 9 months old i noticed his right eye is becoming a squint took to the dr he said we give him 3 more months, but i have doubts from what i have i read. its not noticeable but when am at a distance thats when you can notice. please advice. thank you
February 6, 2009 at 4:00 pm
jacinta,
Some newborn babies have a mild squint that soon goes. However, any squint that is present after the age of three months is usually permanent unless treated. It is important to treat squint in children as early as possible to avoid the development of a ‘lazy eye’ which has a weak vision.
There are 3 causes of squint in children:
1. Refractive errors (i.e. related to vision power).
2. Congenital muscle weakness (which rarely persist after 3 months of age).
3. Brain disorders (rare).
Sometimes the cause is unknown.
So, you should check with another eye doctor. Treatment is usually simple like wearing glasses (if the cause is refractive errors) or ‘eye patching’ (which is putting a patch on the good eye to give a chance for the squinting eye to get better). Surgery is rarely required. There are other options too.
But remember that squint in infants or children needs to be assessed and treated as early as possible.
Hope this helps!
February 14, 2009 at 11:44 am
Dear doctor,
I wase in age of 5years when serious typhide fever attacks on me due to which my left eye was effected and becom squinted.now i m of 26 years, i operates my eye twice time but there is no effect actually my eye is sticked and there is no movement to left and right when eyes are rotated. according to doctors when they gives me anesthesia my body temperature increases due to which they are enable to operate properly.now what you advise for me.kindly
regards,
Masood afzal
from Pakistan
February 14, 2009 at 6:34 pm
Masoood afzal,
You should trust your doctors. You may consult other eye doctors if you need more opinions about that.
Good luck.
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March 14, 2007 at 12:44 am
thank you doctor i’m realy learned from you but i’m still confused a lettel but i’m understand your point ,
with all my best for you doctor.
best wishes for you :
your student from saudi arabia moauia naief