Operations of squint in children under the contract with the National Health Fund
Squint is a disease that is mostly characterised by a misalignment of the visual axes of both eyes, escape of the eye towards the nose or temple. This may result both from disorder of muscles moving the eye ball, which contributes to the change in the angle of view of one eye with respect to another eye, and from congenital, neoplastic and inflammatory diseases of the eye.
Specialised diagnostics and treatment
Already during the first visit, an ophthalmologist can determine if your child has the squint disease.
We begin the diagnostics of the squint disease a detailed initial medical history and performance of basic ophthalmologic examinations, such as:
- determination of visual acuity
- evaluation of alignment of the eyes
- measurement of the angle of squint
- check of binocular vision.
These examinations allow to determine the type of squint and the next steps of treatment. If necessary, your physician may refer to additional diagnostic examinations and consultations with physicians of other specialties. Making the decision on the early treatment of squint is very important, because this phenomenon is the norm only in new-born children and can last no longer then until the early infancy. False is the claim that the child will grow up from squint. The disorder in misalignment of visual axes of both eyes already in a three-month infant is an abnormal phenomenon, requiring consultation with an ophthalmologist.
As part of the diagnostics of the squint disease we perform:
- examination of visual acuity – depending on age: favoured vision test, cards for examining visual acuity, E test, pictorial test
- the Hirschberg corneal reflex test
- the cover-uncover test, with alternate covering the eyes
- examination of eye movability
- examination of refraction (skiascopy, examining with refractometer)
- examination of the anterior segment and the fundus of the eye*
- examination of fixation (visuscopy)
- measurement of the angle of squint: using corneal reflections, with a synoptophore, with a prism, with a Maddox cross
- examination of correspondence, fusion and binocular vision: on synoptophore, polarisation examinations, stereoscopic examinations (stereoscopes)
- examination of disorders of accommodation and convergence with an RAF ruler
- evaluation of vision with a Lea Hyvärinen table
*Examination of the fundus of the eye is performed with dilated pupils, i.e. the so-called paralysis of accommodation. Due to the nature of the examination, the predicted duration of the visit is about 2 hours. After the examination, due to dilated pupils, which will not react to light, there can occur photophobia and worse vision, in particular the near vision. This effect may persist for 4 to 5 hours.
There are cases in which the diagnosis of the squint disease requires a long-term observation of the patient. This may result from the construction of the eye ball, which can create the impression of an apparent squint.
Squint treatment methods
Conservative treatment with the use of eye glasses and lenses
Children with accommodative squint, associated with medium or high hyperopia, are suggested to wear special corrective eye glasses that compensate vision impairment, improve alignment of the eyes and give the opportunity to develop binocular vision. In infants there are used soft silicone eye glasses or contact lenses. In the case of binocular vision impairment and inability to wear eye glasses, special contact lenses are used. Conservative treatment is not always sufficient, in some cases it is necessary to perform the operation.
The aim of surgical treatment, depending on the operated case, is strengthening or weakening the muscles moving the eye ball. Operations of squint are performed under a full anaesthesia and anaesthetic care. Duration of the operation is approximately 30 minutes. For about 1–2 days after the procedure, the patient stays in a hospital ward. The convalescence period lasts up to 6 weeks.
Prior to performance of the operation we commission to perform additional examinations:
- complete blood count
- blood sugar (fasting)
- HCV test
- coagulation test (APTT and INR)
- blood sodium and potassium test
Procedures are performed fasting, therefore it is advisable, that the last meal was 6 hours prior to the scheduled operation. Patients need to strictly follow the recommendations of an attending physician.