When should a child with a squint see an eye doctor?
A squint can be an emergency, a baby phase or a booked visit, and the timing depends on the pattern. The signs that mean today, this week or soon, what the examination involves, and where children are seen in Malaysia.
See an eye doctor today if the squint comes with…
- A new squint in a child whose eyes were straight before needs an eye doctor this week, and the same day with double vision, a headache on waking, vomiting, a drooping lid, unequal pupils or a recent head knock.
- The NHS says to get advice for a squint that is there all the time, or one that comes and goes in a child older than 3 months. In younger babies a squint that comes and goes is common.
- A flat nose bridge and skin folds at the inner corners can make straight eyes look crossed. AAPOS says this is common in babies, but a baby with it can still develop a true squint later, so one check is worthwhile.
- A squint can lead to a lazy eye because the brain may ignore the turned eye. Children rarely complain, so a vision test is often how it is found, and AAPOS says treatment works better the younger the child.
- The examination uses a light reflection, a cover test, a vision test suited to the age and usually drops that relax focusing. Glasses, patching or drops, exercises or surgery follow only if the examination shows they are needed.
- Dr Chan Li Yen, a paediatric ophthalmologist in Petaling Jaya, is one doctor who examines children's squints.
A new squint needs an eye doctor this week, and the same day with double vision, a headache on waking or vomiting. A turn that stays, or still comes and goes after three to four months of age, needs checking too.
Dr Chan Li Yen, paediatric ophthalmologist in Petaling Jaya, writes this journal, and this page puts the timing in one place: what cannot wait, what can be planned, what the examination involves and where children are seen. The full picture of squint types and treatment is in squint and lazy eye in children: a parent's guide.
When should a child with a squint see an eye doctor?
It depends on the pattern. A turn that appeared suddenly, with double vision, a headache on waking, vomiting, a drooping lid, unequal pupils or a recent head knock, needs a doctor today. A new turn on its own needs one this week. A turn that is there all the time, or still comes and goes after three to four months, needs a booked visit soon.
The NHS says to get advice if a child has a squint all the time, or is older than 3 months and has a squint that comes and goes. In babies younger than that, a squint that comes and goes is common and not usually a concern.
The NHS also says a squint is unlikely to get better on its own, and that it can lead to a lazy eye if it is not treated early. "Booked" is the important word: a squint that is merely noticed and watched is not yet a squint that has been checked.
What if the squint appears suddenly?
Treat it as urgent. A squint that arrives in a child whose eyes were straight before should be examined this week, and the same day if it comes with double vision, a headache on waking, vomiting, a drooping eyelid, one pupil larger than the other, or a turn after a knock to the head or during a feverish illness.
The reason is the nerve. The sixth cranial nerve moves the eye outward, towards the ear. AAPOS lists stroke, trauma, viral illness, brain tumour, inflammation, infection, migraine and raised pressure inside the head among its causes, says the commonest cause in children is trauma, and names double vision as the main symptom. Many sudden turns turn out to be something more ordinary, such as the eye working hard to focus, but only an examination can say.
One thing a parent can check at home: hold a toy at your child's eye level, keep the chin still and move it slowly to one side and then the other. If one eye stops short of the far corner, say exactly that when you telephone. Scroll back through flash photographs as well.
The last picture with unmistakably straight eyes dates the change, and the NHS lists a squint among the possible signs of retinoblastoma, a rare childhood eye cancer, which is why it advises any child with a squint to see a doctor. The longer account is in sudden squint in a toddler: when it is urgent.
Is a baby's crossed eye normal, or is it the nose bridge?
Often one of those two, in the first months. Newborn eyes wander a little while the pair learn to work together, and a wide, flat nose bridge with small skin folds at the inner corners can make straight eyes look crossed. That look is called pseudostrabismus, or juling palsu in Malay, and AAPOS says it is very common in babies and most grow out of it.
The AAO adds that a child can outgrow pseudostrabismus but not a true strabismus. A doctor tells them apart by shining a light and checking where the reflection sits in each pupil. In a straight eye it falls in the centre of both at once.
A photo cannot settle it, and AAPOS warns that a baby with pseudostrabismus may develop a true squint later, so one check, and a question about when to come back, is worthwhile. It also notes that some Asian children keep a broad nose bridge as they grow. More on this in when it is the nose bridge, not a squint and cross eyed baby: what is normal.
Does a squint that comes and goes need a doctor?
Yes, a check, though not an emergency. An eye that turns outward some of the time and is straight the rest is called intermittent exotropia. AAPOS says it can happen when a person is tired, sick or daydreaming, and sometimes when looking at things far away. The NHS advice for a child older than 3 months applies.
What helps the doctor most is a description: when it happens, how often, and whether it has changed lately. A short phone video of a drifting moment is useful, because the eye is often straight in the consulting room. See a doctor sooner if the drift becomes clearly more frequent over weeks, if a head tilt appears, or if it turns constant. How these children are followed over time is in the squint that comes and goes.
Can a squint cause a lazy eye?
Yes. When the eyes point in different directions, the brain receives two pictures and may ignore the one from the turned eye. That eye then does not learn to see well, which is a lazy eye, or amblyopia, called mata malas in Malay. The AAO says this happens when the misaligned eye has weaker vision.
AAPOS notes that children do not usually complain, because the better eye carries them, and that the weaker eye may look normal, so a problem is often found only with a vision test. It also says amblyopia should be treated as early as possible because treatment works better in younger children, and the NHS says vision problems may be permanent if not treated young.
A lazy eye can also sit behind eyes that look straight, which is why the check matters even when the alignment looks fine. See lazy eye: how to spot the drift and the hidden weak eye.
What happens at the eye examination for a squint?
The doctor checks alignment, tests vision in a way that suits the child's age, and measures for glasses. No reading is needed. AAPOS describes shining a light on both eyes to see where it reflects and a cover test, in which each eye is covered in turn while the doctor watches how the eyes move.
Young children are tested with pictures or shapes, as how we test children's eyes explains, and the examination usually includes drops that relax focusing so that the glasses measurement is accurate, covered in about those eye drops at the clinic. What follows depends on the cause.
The AAO says glasses can correct a squint when blurry vision makes the eyes strain, patching or drops may be advised for a weaker eye, and surgery on the eye muscles is sometimes needed, under general anaesthesia. The NHS adds that eye exercises may sometimes help. None of these is promised in advance: the examination decides.
Where are children seen for a squint in Malaysia?
In two broad places. In the public route, a klinik kesihatan or GP refers the child to the eye clinic of a government hospital, and the referral letter and any earlier prescriptions go with you. In the private route, an eye centre or hospital that sees children can be booked directly. Neither is a lesser choice, and when your child's eyes are actually checked in Malaysia explains the school and klinik kesihatan checks that may flag a squint first.
Dr Chan Li Yen, a paediatric ophthalmologist in Petaling Jaya, is one doctor who examines children's squints. The About page says where she practises, and how to check a children's eye specialist is registered shows how to run the same check on any doctor. If surgery is ever advised, squint surgery in Malaysia: the wait and what to ask sets out what to ask.
- Double vision, or your child starts closing one eye to look at you.
- A headache that wakes your child, or vomiting that no tummy bug explains.
- A drooping eyelid, or one pupil larger than the other.
- A turn that appeared after a knock to the head or during a feverish illness.
- A white or pale glow in the pupil in a photograph or in low light.
Common questions
At what age should a squint be checked?
Will my child's squint go away on its own?
Is my baby's cross eye normal?
Is a squint an emergency?
What is the difference between a squint and a lazy eye?
Which doctor should I see for my child's squint in Malaysia?
- NHS · Squint · www.nhs.uk
- American Academy of Ophthalmology · Strabismus in children · www.aao.org
- AAPOS · Pseudostrabismus · aapos.org
- AAPOS · Amblyopia · aapos.org
- AAPOS · Sixth nerve palsy (cranial nerve VI palsy) · aapos.org
- AAPOS · Exotropia · aapos.org