Question

I have suffered from an estropic squint since birth. During infancy I had two corrective operations, which while correcting my squint to some extent, did not cure it completely. Recently, I am now 21, I have started to consider having it fixed completely. I consulted my doctor who sent me to a specialist at Birmingham's Selly Oak hospital. He was incredibly negative, said it couldn't be fixed and said I'd have to put up with the jokes etc from my friends. The nurse there on the other hand told me seperately that my squint could be corrected and it was a relatively straightforward operation. I am keen to find out if it is operable, given my age, and the fact I have had two previous operations. Would I be likely to suffer from double vision after the operation, as this is soemthing that concerns me greatly. Finally, my girlfriend is a medical student and recently read about Bototoxin injections that could be injected into the eye muscle to cause temporary (ie a few months) squint correction. Is this avenue worth persuing? I would very much appreciate your opinion.

Thankyou

(William Wright)

Answer:

Dear William,

First of all, are your farsighted and do you really need glasses ? Then that should first be corrected, as the squint angle may be greatly reduced by wearing plus glasses. Secondly, it the squint angle larger that about five degrees when wearing the proper glasses ? If so, consult an ophthalmologist that does a lot of strabismus surgery and have everything measured. Thirdly, it may well be impossible to have your squint corrected any further because of double vision that may occur in patients with convergent squint over age ten even when their eyes are straight because of "anomalous retinal correspondence (ARC)". ARC is an internal squint in the brain that wholy or partly corrects a squint of the eyes, to the effect that the image of the squinting eye is shifted. In these cases, the angle of squint cannot be corrected to zero. The orthoptist that examines the patient usually checks for this by placing a base out prism in front of the squinting eye, to simulate the situation after surgery. If the patient does not see double when the eyes are made optically straight by means of the prism, an operation is possible.

Yours truly,

(Herb Simonsz, MD, PhD)

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