Adult squint, or strabismus, occurs when the eyes do not align properly. Although often associated with children, it affects about 4% of adults and can be caused by a range of factors.
In adults with a squint, one eye looks straight while the other may drift inwards, outwards, upwards, or downwards, leading to symptoms such as double vision, eye strain, headaches, reduced depth perception, and blurred vision. The visible misalignment can also impact social interactions and self-confidence.
Early diagnosis and treatment of adult squint can significantly improve vision and quality of life. At Moorfields Eye Hospitals Dubai and Abu Dhabi, our expert team uses advanced techniques to effectively diagnose and treat adult squint.
Causes of Squint in Adults
Adult squints are of three main types: non-paralytic, paralytic and restrictive.
- Non – Paralytic Squint: In some adults, a squint from childhood may return later in life, even if it was treated or surgically corrected. These cases are generally non-paralytic, meaning the eye muscles are not weakened.
- Paralytic Squint: This type is due to weakened or paralyzed eye muscles, often resulting from nerve damage. Causes include head injuries, strokes, or conditions like diabetes and high blood pressure.
- Restrictive Squint: This occurs when eye muscles are restricted, limiting movement due to factors like scarring or muscle tethering.
Symptoms of Squints in Adults
Adults with squints may experience:
- Double Vision (Diplopia): Seeing two images due to eye misalignment.
- Eye Strain and Fatigue: Especially noticeable during near tasks like reading.
- Difficulty with Close-Up Vision: Using a computer or reading may become challenging.
- Abnormal Head Posture: Tilting or turning the head to reduce double vision.
- Loss of Depth Perception: Difficulty judging distances, affecting daily activities.
Risk factors for developing Squints in Adulthood
Several factors increase the likelihood of adult squints:
- History of Childhood Squint: Untreated squints or previous squint surgeries in childhood may lead to issues in adulthood.
- Neurological Disorders: Conditions such as stroke or brain injury that affect eye muscle control.
- Medical Conditions: Diseases like diabetes or thyroid disorders increase the risk of squints.
- Trauma: Injuries to the eyes or surrounding structures can disrupt normal alignment.
- Age-Related Changes: Muscle and nerve changes from aging can cause squints, even in adults without prior eye issues
Diagnosing a squint in adults requires a thorough eye exam by an ophthalmologist or orthoptist, including:
- Eye movement and alignment tests: To assess how the eyes move and measure alignment.
- Eye coordination tests: To determine how well the eyes work together.
- Visual acuity test: To check for any vision loss.
- Refraction testing: To evaluate refractive errors.
- Imaging: Scans may be used to find underlying causes.
- Blood tests: Tests may be carried out to identify any underlying systemic condition
Treatment for squint depends on the severity and there are several approaches to treatment.
- Conservative Treatment: In some cases, eye exercises or prisms can help manage symptoms, particularly if the squint is changing or resolving.
- Non-Adjustable Surgery: This procedure, done under general anesthesia, adjusts the eye muscles to improve alignment. It usually takes about an hour, with most patients going home the same day.
- Adjustable Surgery: A two-step approach that involves:
- Main Surgery: Eye muscles are repositioned under general anesthesia.
- Adjustment: After waking, the final muscle position is fine-tuned using adjustable sutures, usually under local anesthesia. This method is beneficial for patients with complex cases, previous surgeries, or double vision. Adjustment may cause slight pressure or discomfort.
Goals of Squint Surgery for Adults
Squint surgery for adults aims to:
- To improve the alignment of the eyes, to make the squint smaller in size.
- In some patients, to reduce or try to eliminate double vision.
- Occasionally to improve an abnormal position of the head.
Post-Operative Care
After surgery, patients may experience mild discomfort, redness, or swelling that usually subsides within a few days. Post-operative care includes:
- Use the eye drops to reduce infection risk and control inflammation
- Use painkillers such as paracetamol and ibuprofen if the eyes are painful
- Use cooled boiled water and a clean tissue or cotton wool to clean any stickiness of the eyes and avoid water entering the eyes from the bath or shower for the first two weeks
- Do not rub the eye(s) as this may loosen the stitches
- No swimming and heavy lifting activities
- Attend the post-op clinic appointment to monitor healing and alignment.
- Continue using glasses if you have them
- Avoid contact lens wear in the operated eye(s) until advised it is safe by the doctor or orthoptist.
While many patients notice improvement within weeks, full recovery can take a few months, depending on the case.
Adult Squint (Strabismus) Specialists
Dr. Suhair Twaij
Consultant Ophthalmologist in Adult & Paediatric Strabismus Surgery, Paediatric Ophthalmology, Adult Cataract Surgery GCAA Approved Specialist Aviation Medical Examiner
Dr. Suhair Twaij is a Consultant Ophthalmologist with a subspecialist interest in adult and paediatric Strabismus surgery, Paediatric Ophthalmology, adult Cataract Surgery and General Ophthalmology at Moorfields Eye Hospital Dubai.
Dr. Twaij recently relocated to the UAE from the UK, where she has worked as a consultant ophthalmologist at the Royal Victoria Hospital in Belfast since 2013. She was also the clinical lead for the adult motility service in Northern Ireland from 2014.
She holds a graduate degree in medicine from the Baghdad University Medical School, obtained in 1994.
Her areas of expertise include complex adult and paediatric squint surgery using the adjustable technique when needed, double vision correction, adult cataract surgery with an implant, Botox treatment for squints, double vision, blepharospasm and aesthetics.
She has over 20 years of experience in general ophthalmology, including cataract surgery, anterior and posterior segments such as glaucoma and diabetic retinopathy.
Dr. Suhair trained in the UK from 2004 in England and Northern Ireland and was awarded the certificate of completion of training (CCT) in ophthalmology in the UK in 2012. She was awarded the Royal College of Ophthalmologists Fellowship in the same year.
Throughout her career, she has practised in leading medical institutions such as The Royal Victoria Hospital in Belfast, Northern Ireland, Altnagelvin Area Hospital, Northern Ireland, The Bristol Eye Hospital, England, and King Hussein Medical City Amman, Jordan.
Dr. Suhair is an avid researcher and has Medline-published papers in various ophthalmology topics such as medical retina, paediatric ophthalmology and oculoplastics.
She is a member of the Royal College of Ophthalmologists, the British & Irish Paediatric Ophthalmology and Strabismus Association (BIPOSA) and the European Association of Strabismus (ESA).
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Dr. Imran Jawaid
Consultant Ophthalmologist in Paediatric Ophthalmology and Strabismus surgery
Dr. Imran Jawaid is a Consultant Ophthalmologist, specialised in Paediatric Ophthalmology and Strabismus, at Moorfields Eye Hospital Dubai in Dubai Healthcare City.
He holds a Bachelor of Medicine, Bachelor of Surgery (MBChB) degree in Medicine from the University of Leicester, School of Medicine, graduating with honours in 2010. He is also dual qualified as an Optometrist with a Bachelor of Science (HONS) degree in 2003. Dr. Imran has completed his Fellowship with the Royal College of Ophthalmologists (FRCOphth) and obtained his Certificate of Completion of Training (CCT) in Ophthalmology in 2020.
Dr. Imran has more than 15 years of experience in Ophthalmology in the United Kingdom and has completed a post-CCT fellowship in Paediatric Ophthalmology and Strabismus at Birmingham Children’s Hospital, UK. Most recently he was a Consultant Ophthalmologist and Head of Service for Ophthalmology at Nottingham University Hospitals, NHS Trust, a large tertiary centre for ophthalmic referrals.
He has undertaken research in myopia, visual impairment, diabetic macular oedema and emergency ophthalmology, amongst other areas and has published over 10 research papers in leading journals. In addition to his research, Dr. Imran is a keen educator and has taught at different UK medical schools and contributed to book chapters in Ophthalmology.
He is a member of the Royal College of Ophthalmologists (FRCOphth) and is the recipient of several internationally acclaimed awards and recognitions.
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Dr. Salma Yassine
Specialist in Paediatric Ophthalmology and Adult & Paediatric Neuro-ophthalmology
Dr. Salma Yassine is a specialist Ophthalmologist who specialises in Paediatric Ophthalmology and Adult and paediatric Neuro-Ophthalmology at Moorfields Eye Hospital Dubai in Healthcare City Dubai.
She holds a bachelor’s in science (2012) with high distinction and a medical degree (2016) from the American University of Beirut. She finished Her ophthalmology residency at the American University of Beirut Medical Center in 2020 before pursuing a fellowship in neuro-ophthalmology at the University of Minnesota in 2021, followed by another fellowship in pediatric ophthalmology and strabismus at Children’s National Medical Center in Washington DC.
She has international experience in paediatrics and neuro-ophthalmology in countries including the USA and Lebanon.
She has practised in leading medical institutions such as the University of Minnesota and the Children’s National Medical Center in the US.
She has researched intracranial hypertension and nanophthalmos and published research papers on nystagmus and nanophthalmos in leading journals.
She is a member of the American Association for Pediatric Ophthalmology and Strabismus Association (AAPOS) The North American Neuro-Ophthalmology Society (NANOS), and the Lebanese Ophthalmological Society (LOS)
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