The short answerA squint (strabismus) in children means the eyes do not point in the same direction at the same time, so one eye turns in, out, up or down, all the time or now and then. Brief eye turns in the first 3 to 4 months can be normal, but a squint that continues after that needs an eye exam. A squint does not go away as the child grows. Depending on the type, treatment may be glasses, treatment for an associated lazy eye, or eye muscle surgery.
Types of squint
| Type | Direction | Notes |
|---|---|---|
| Esotropia | Inwards, towards the nose | Can appear in the first months, or at around two or three years with long-sightedness. This type can improve a lot with glasses |
| Exotropia | Outwards, towards the ear | Often intermittent: shows when tired, daydreaming or unwell, and the child may close one eye in sunlight |
| Vertical squint | Up or down | Less common, and the child may tilt their head to see clearly |
A squint can be constant, or intermittent, showing at some times and not others. An intermittent squint also needs an exam, because it can increase over time and become constant.
False squint: an eye that looks turned but is not
Many babies and young children have a wide, flat bridge to the nose or a fold of skin at the inner corner of the eye. This hides some of the white of the eye on the nose side, so the eye looks turned in, especially when looking sideways. This is called pseudo-strabismus, or false squint, and it becomes less noticeable as the face grows.
A useful sign: in a flash photo, a child without a squint has the light reflection in the centre of both pupils. Only a doctor can confirm it, though, so if you are unsure, an exam is better than assuming it is a false squint.
When is an eye turn normal and when is it not?
- In the first 3 to 4 months: brief eye turns can be normal while the baby is learning to coordinate the eyes.
- A constant squint at any age, even in the first months: needs an exam.
- A squint that continues or appears after about 4 months: needs an exam.
- An intermittent squint parents notice when the child is tired or in photos: needs an exam, though not urgently.
Signs that need an urgent exam
- A squint that appears suddenly at any age, in a child or an adult.
- A squint with double vision.
- A squint with headache, vomiting, unusual drowsiness, or weakness of the face, arms or legs.
- A white reflection in the pupil in photos.
These signs can point to a problem with the eye nerves, the brain or inside the eye, and need a doctor the same day or a visit to the emergency department.
"They will grow out of it": why a squint should not be left
A true squint does not go away with age, and waiting has a cost. When one eye turns, the brain ignores its image to avoid double vision, so that eye's vision weakens and a lazy eye develops. The child also loses some ability to judge depth with both eyes together, and may be affected emotionally and socially as they grow. Sometimes the squint itself is a sign of another problem, such as strong long-sightedness or poor vision in one eye from a problem inside it. That is why every child with a squint needs a full exam, including a prescription check with dilating drops and a look at the back of the eye.
Treating a squint
- Glasses: in esotropia linked to long-sightedness, glasses can fully or partly straighten the eyes, and they need to be worn all day.
- Lazy eye treatment: patching the stronger eye or atropine drops, as the doctor advises. This treats the reduced vision but in most cases does not change the eye's position.
- Eye muscle surgery: the pull of one or more of the muscles that move the eye is adjusted. The surgery is done on the muscles on the outside of the eye, without entering the eye itself. Some children need more than one operation and may still need glasses afterwards.
- Eye exercises: help only in specific types, such as convergence insufficiency (difficulty turning the eyes in for reading), and do not treat most squints.
The choice and timing of treatment depend on the type and size of the squint, the child's age and whether there is a lazy eye, and are decided by a paediatric ophthalmologist after the exam.
Frequently asked questions
Will my child grow out of a squint?
No. A true squint does not disappear with age, and leaving it can cause a lazy eye and poorer depth perception. Only a false squint fades as the face grows, and a doctor can tell the two apart.
My child's eye only drifts when tired. Do they need an exam?
Yes. An intermittent squint that shows when tired or daydreaming needs an exam to identify its type and monitor it, because it can increase over time.
At what age is squint surgery done?
There is no single age. Timing depends on the type and size of the squint and how it responds to glasses and lazy eye treatment. Some types are operated on in the first years, while others are monitored first.
How can I tell a real squint from a false one?
In a flash photo, a child without a squint has the light reflection in the centre of both pupils. This is only a helpful sign, and an eye exam confirms it.