Children can be born with squint or develop it in childhood.
It can be constant or intermittent, occurring when the child is tired or daydreaming. It can also be alternating, sometimes seen on the right and sometimes on the left eye.
When the eyes are straight, images formed in each eye are sent to the brain and it is fused into a single, three dimensional (3D) image which gives us depth perception. When a child has a squint, two different images are sent to the brain. The brain learns to ignore the image seen by the misaligned eye and after some time the image is being suppressed.
This condition is called amblyopia or lazy eye. Adults who are recently diagnosed with a strabismus often complain of double vision (diplopia) because the brain is unable to ignore the different images.
In general, most children do not complain of eye problems or notice changes in their vision. Common signs and symptoms seen are: closing one eye to see
There are many types of squints but the two most common forms are below.
| Condition Term | Misalignment Direction | Quick Brief |
|---|---|---|
| Esotropia (Inward) | One or both eyes turn inward toward the nose | Often associated with uncorrected farsightedness in young children. |
| Exotropia (Outward) | One or both eyes drift outward toward the ears | Frequently occurs when viewing distant objects or when tired/unwell. |
| Hypertropia | Upward | The affected eye is misaligned higher than the straight eye. Can cause vertical double vision and head tilting. |
| Hypotropia | Downward | The affected eye is misaligned lower than the straight eye. Less common, often linked to eye muscle restriction or trauma. |
Accommodative Esotropia often occurs because of uncorrected refractive error. When a child has uncorrected far- sighted/ hypermetropia, one will tend to accommodate to focus. People who are far-sighted have to focus extra hard to keep images clear.
This may cause the eyes to turn inward. It usually occurs at age 1 to 3 years old. Glasses are usually prescribed to improve the focusing ability, enabling the eyes to straighten.
After glasses correction, Fully accommodative squint can be totally corrected just with glasses whereas in some cases which are Partially accommodative squint a child needs muscle alignment surgery for significant residual squint.
Intermittent exotropia occurs when one eye drifts outwards occasionally. It usually manifest during illness, fatigue and more often when viewing at a distance. Treatment varies. In some, non-medical treatment like spectacles, eye patching or eye exercises are appropriate; while in others, eye muscle surgery is necessary.
A squint can be diagnosed during a full eye examination. If you suspect that your child has a squint or if there is a family history of squint or amblyopia, it is advisable that you bring your child for a complete eye exam by an ophthalmologist to find out the cause because in some patient a life threatening cancer or permanent scar in the eye can be the underlying reason why the child is not focusing well.
Once the diagnosis is established, the treatment plan can be discussed to help your child accordingly.
Diagnosis involves a comprehensive pediatric eye examination including visual acuity testing, refraction tests to check for glass prescription needs, cover tests to evaluate alignment, and dilated fundus examinations to inspect the retina and optic nerve.
At OasisEye Specialists, our fellowship-trained paediatric ophthalmologists and squint surgeons specialize in diagnosing and correcting eye misalignment (strabismus) and related vision conditions in both children and adults. With dedicated expertise across key centers in Malaysia—including Kuala Lumpur, Penang, and Kuching—our team provides comprehensive evaluation and advanced surgical interventions tailored to restore proper eye alignment, improve visual function, and prevent long-term vision loss. Namely Dr Sunder Ramasamy, Dr. Norazah Abdul Rahman, and Dr. Norhafizah Hamzah.
There is no difference. “Strabismus” is the medical term for a condition where the eyes do not align or focus together, while “squint” is the commonly used lay term. Both describe an inward, outward, upward, or downward turn of one or both eyes.
No, children do not outgrow a true squint. Any misaligned eye after 3 to 4 months of age requires evaluation by an ophthalmologist. Leaving a squint untreated can lead to permanent vision loss in that eye (amblyopia or “lazy eye”).
Squints are caused by poor coordination between the eye muscles, uncorrected vision errors (like farsightedness/hypermetropia), or neurological factors affecting eye movement control. In rare instances, a squint can indicate an underlying eye scar or tumor, making early screening essential.
Accommodative Esotropia is an inward eye turn caused by uncorrected farsightedness, often treatable with glasses alone. Intermittent Exotropia is an outward drifting of the eye that usually appears when a child is tired, unwell, or looking at distant objects.
No. Many squints can be successfully managed using non-surgical treatments such as prescription eyeglasses, eye patching (occlusion therapy), or eye exercises. Surgery is only recommended if significant residual misalignment remains after optical correction.
Squint surgery adjusts the tension of the extraocular muscles on the outside of the eyeball. The surgeon either weakens or strengthens specific muscles to realign the eye straight ahead. It is a precise procedure performed on the eye exterior without entering the eyeball itself.
Yes, adults with strabismus can undergo treatment regardless of age. Adult squint treatment — whether through prism glasses or muscle alignment surgery — can correct double vision (diplopia), restore depth perception, and improve aesthetic alignment.
Amblyopia occurs when the brain suppresses or ignores the visual input from a misaligned eye to avoid confusion or double vision. Over time, visual development in that eye stalls. Early treatment of the underlying squint can prevent or reverse lazy eye.
You should schedule an evaluation immediately if you notice constant or worsening eye turning, persistent head tilting, squinting one eye in bright sunlight, frequent trips or falls due to poor depth perception, or a white reflection in the pupil.
At OasisEye Specialists, squint surgery under general anaesthesia ranges from RM8,000 to RM13,000, depending on the complexity of the case. International patients are subjected to an additional 6% SST.
