Operation: Surgery is by far the best and most vital part of the treatment. The operation is performed on the strings of the muscles which move the eyeball in all directions. These muscles are either made strong or loosened, depending en the type of cross-eye. Lf the eye is crossed to the inner side, the outside muscle is made strong so that it pulls it outwards and the inside muscle is loosened to relax itself. The opposite procedure is adopted if the eyeball is crossed to the outer side. A similar procedure is adopted for the upper and lower muscles if the eyeball is pointing upwards 0:downwards. (Cross-eyes are more common in the horizontal direction). The procedure is based on the mathematical and anatomical calculations and on the past judgment of the surgeon. It should be noted that in no case does the eyeball have to be opened and there”, should be no alteration of any other structure of the eye whatsoever.
This method brings gratifying results in cases of early squints. (Throughout this discussion the word ‘early’ has been repeated to show how important it is to be treatment as soon as the squint is detected.) The provision of glasses, exercises and forcible use of eye are all aimed at bringing the eyesight to optimal level. The finishing touch of straightening the eye is performed by surgery. All four procedures, either individually or collectively, are put into practice to give better vision to the eye.
The child should be examined in the eye clinic after the operation. The child may need exercises or a subsequent change in glasses. Operating on a squint is the final and finishing touch, akin to the gloss an architect gives a building whose “foundation, brickwork and woodwork are already done.
Ideal Age for Squint Surgery
The ideal age for squint surgery is between two and four years. Parents are often. Reluctant to get their children operated at this age because of fear. This is an unpardonable error. It should be clearly understood that surgery, under modern methods of anesthesia and surgical craft, will produce the best results at this age. The outer limit at which cross-eye can be operated is four or five or six years, which is also the school-going age. If surgery is done before this, the child enters school with straight eyes and has all the confidence and courage needed.
Danger of Delay
Leaving the cure of cross-eye to Nature and time is catastrophic because the cross-eye then gradually becomes lazy and blind. If the cross-eye is not in use, the brain shuts itself from recovering any impression from the source. The blindness is not in the eyeball but in the brain centers. The age limit by which the brain: entres will adjust is five or six years. During this vital period the brain reflexes are in the process of being laid down. They can be altered to the requirements of the eyes during this phase. Once the age passes the battle is lost. If the age is passed, the operation can make the eye straight but the eye will remain partly or totally blind. The complication due to delay does not stop here, because even though the eyeball is made straight by operation it has a tendency to revert to its original position of ‘cross’ in due course. According to Canvases, a French scientist, a child with the squint has moral right to be put in the care of a specialist the moment the squint is detected.
Cross-eye in children after the age of ten is usually due to paralysis of muscles controlling the eye movements. This can also occur in small children, which the eye specialist alone can differentiate and deal with. In older children, cross-eye by paralysis is due to:
- an accidental fall on the head, causing internal injury to the brain or the eyes directly;
- brain fevers, typhoid, diphtheria, meningitis or brain abscess;
- smallpox; and
- Diseases of the brain matter due to unknown causes.
The paralysis ~f the eye muscle is a part of the disease of the nerves coming out from the brain. The eye sc involved is treated like any other paralyzed muscles the body. Here the contrast is very marked. No surgeries advocated. The nerves and muscles are given rest tonics to regain lost strength. With the passage of time about 50 per cent of these cases recover partially completely. As opposed to the squints of children who operation is not to be delayed, the paralyzed cross -eye must be straightened only as a last resort or not at all. In modern clinics, treatment with electric heat (diathermy) and physiotherapy brings out gratifying results. Operating delayed cases of squints, which begin in childhood but are neglected, can make the eyes straight, irrespective of age. In this case, however, while the cosmetic results are good, the sight, in all probability, is not restored.
An eye may become ‘cross’ due to long-standing blinding disease. A blind eye of long standing has a tendency to turn outwards. This is the natural position of rest when the eye is not used for vision. It becomes lazy and diseased. A cross-eye of this kind cannot be set right unless the blinding disease is treated at a very early stage.