6th July 1997


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That nickname and its origins

by Dr. Sanjiva Wijesinha

Children can be ex traordinarily cruel. I remember a chap I knew in school who had the singular misfortune of having been born with a squint.

From the time I first got to know him, he was known as ‘Vaparaya’ - and even now, years after he had his squint surgically corrected, he is still known by this unfortunate nickname.

The only difference is that now, out of deference perhaps to his advanced years, his contemporaries referred to him by the slightly less offensive shortened form of "Vaps".

What exactly causes a squint - or Strabismus, to give the condition its correct medical name?

Basically, what happens is that the muscles that move the eye do not work in co-ordination. When the eyes need to look at an object, these muscles rotate them or turn them left or right as the case may be, so that both eyes can focus on the object, to provide what is equivalent to binocular, three-dimensional vision. In squint, one eye usually turns inward (though in some cases it may turn outwards or up or down).

Since the brain then receives two images that are not in focus, it compensates by suppressing one of these images.

Since the image from the squinting eye is suppressed by the brain, a condition termed Amblyopia, where the vision is lost in this eye, can supervene. If not treated, this can go on to virtual blindness in the squinting eye.

There are three main methods of treating amblyopia - patching, glasses and drugs.

Patching involves covering the good eye with an eye patch. This encourages the squinting (or "lazy") eye to work, and forces the brain to recognise the image coming from it.

Patching is highly successful in children under the age of seven.

Glasses may help to improve vision and may increase the child’s chances of using both eyes together as a pair. Often, this form of correction is used in conjunction with patching.

Sometimes, drugs may be prescribed in the form of eye-drops to be instilled into the good eye. These blur vision in this eye, and so force the "lazy" eye to work properly. If eye-drops are used, the pupil on that side becomes larger and the child may be affected by glare. After such medication is stopped, the pupil takes about ten days to return to normal size.

Some children may need surgery to have their squints corrected - and often, more than one operation is required. Under a general anaesthetic, the surgeon can, by shortening or lengthening the muscles that move the eyeball, correct the rotation of the eyeball and "so make it look straight".

Surgery, however, cannot correct the amblyopia. Squint correcting operations, therefore, can only be performed after the amblyopia is corrected.

There are various factors that can cause a child to squint.

One group are the congenital squints. Other causes are the need for glasses, such as long-sightedness or short-sightedness.

A latent squint can manifest when one is tired, when concentrating on a close object, or when one is sick or upset. They can develop at any age.

The important thing to know is that it is never too early to have your child examined for a squint - amblyopia can be diagnosed and treated effectively only if the child is taken for assessment early enough.

Remember, a child will never "grow out" of amblyopia or squint.

Neither, for that, matter, can it grow out of its childhood nickname.

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