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What is an effective treatment for squints?

Q: My son is 4 years old. We noticed a squint in his eyes two years back and were advised glasses by the consultant doctor. These glasses were of the power right eye: +5.50 spherical, + 0.75 cylindrical, 20 degrees, left eye: +6.00 spherical, +0.5 cylindrical, 160 degree. On wearing glasses there was improvement in the eyes with some squint remaining in the right eye. Now we have shown him to some other according to whom the child still has a squint in the right eye with the right eye moving (converging) or aligned towards the nose. The new spectacles advised by the doctor were powered - right eye: +7.75 spherical, +1 cylindrical, 20 degrees and left eye: +7.75 spherical, +1 cylindrical, 155 degrees. The doctor told us in advance that while wearing glasses the squint should not be visible. Now after our son wore these new glasses for 5 days we noted that the right eye was converging even more towards the nose as compared to earlier (before wearing the new glasses). We went back to the doctor and told him that the right eye was converging even more towards the nose after the child took the glasses off. In response we were told that this was normal as long as the squint did not appear while the glasses are on. Please advise.

A:It appears that this child has a fully accommodative esotropia for, which the treatment is glasses alone. In such a case, if prescribing the full refractive correction correctly aligns the eyes then the child must bear the glasses constantly. (The parents must understand that the squint is appearing because of a need for the correct refractive power.) Removal of the glasses will make the squint re-appear and that is normal. If a squint persists despite full refractive correction or there is a squint for work, then a further evaluation is necessary.


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