Squint is a condition where the eyes are unable to focus on a target simultaneously. It is a type of extraocular muscle disorder and can be classified into two main types: concomitant squint and paralytic squint. Concomitant squint is characterized by equal degree of deviation in both primary and secondary positions without any movement impairment of the eyeballs. Paralytic squint, on the other hand, involves limited eye movement, double vision, and can be congenital or caused by trauma or systemic diseases.
Clinical Manifestations
In patients with squint, when they focus on an object, the image of the object falls on the fovea centralis in the retina of the normal eye, while in the squinting eye, it falls outside the fovea centralis, causing double vision. One image is suppressed, resulting in loss of binocular vision and depth perception. It can also lead to poor visual development and amblyopia.
1. Esotropia (Inward Squint)
The eye deviates inwardly. Esotropia that occurs from birth is called congenital esotropia. The deviation angle is usually large. Acquired esotropia can be divided into accommodative and non-accommodative types. Accommodative esotropia often occurs in children aged 2-3 years and is usually associated with moderate to high hyperopia or abnormal accommodative convergence and accommodation ratio.
2. Exotropia (Outward Squint)
The eye deviates outwardly and can be intermittent or constant. Intermittent exotropia occurs when the patient has good fusion ability and the eye position remains normal most of the time, only occasionally showing an outward deviation when exposed to sunlight or when fatigued. Some children may even close one eye in bright sunlight. Intermittent exotropia can progress to constant exotropia.
3. Hypertropia (Upward or Downward Squint)
The eye deviates upward or downward and is less common than esotropia and exotropia. Hypertropia is often accompanied by head tilt as a compensatory position.
Childhood squint is a common childhood condition. Do you know how to massage and treat squint in children in daily life?
Massage Method 1
1. Common Techniques
(1) The child sits or lies down, and the parent uses their thumb to gently massage the area around the eyes, starting from the Yintang acupoint, for 1-3 minutes on each side.
(2) Use the fingertips of the index and middle fingers to simultaneously press the Sizhukong acupoint on both sides, rotate counterclockwise, and repeat for 1 minute.
(3) Use the thumb pads of both hands to simultaneously press and knead the Yuyao acupoint on both sides for 1 minute.
(4) Use the middle finger pads of both hands to simultaneously press and knead the Taiyang acupoint on both sides for 1 minute.
(5) Use the index finger pads of both hands to simultaneously press and knead the Sibai acupoint on both sides for 1 minute.
(6) Pinch and knead the Hegu acupoint 15-30 times.
(7) The child lies down with eyes closed, and the parent uses the radial side of both thumbs to gently stroke from the Sizhukong acupoint to the Taiyang acupoint 50 times. Do not touch the eyes during the process.
(8) The child lies prone, and the parent uses their fingers to press and knead the Ganshu and Shenshu acupoints for 1 minute each.
2. Additional Techniques
(1) If the child has fever, convulsions, or restlessness, the following techniques can be added:
① Press and knead the Dazhui acupoint for 1 minute.
② Rub the Yongquan acupoint 300 times.
③ Use the base of the palm to rub the muscles on both sides of the spine, with moderate pressure.
(2) If the squinting eye has blurred distance vision, severe nearsightedness, and accompanying orbital and frontal headaches, the following techniques can be added:
① Massage the Fengchi acupoint on the same side for 1-3 minutes, until a sense of distention and heaviness is felt in the head.
② Tonify the Kidney meridian 300 times, and tonify the Liver meridian 300 times.
Massage Method 2
1. Common Techniques
(1) The child sits or lies down, and the parent uses their fingers to press and knead the Jingming, Chengqi, Sibai, and Taiyang acupoints for 1 minute each. Then, use the pads of both thumbs to gently rub the area around the eye sockets, repeating for 1-3 minutes.
(2) The child lies prone, and the parent uses their fingers to point and knead the Ganshu, Danzhong, and Shenshu acupoints for 1-3 minutes each.
(3) Use the fingers to pinch and knead the Hegu and Guangming acupoints on the opposite side of the squinting eye for 1-3 minutes each.
2. Lifestyle Adjustment
(1) Pay attention to resting with closed eyes to reduce eye fatigue. Children with squint should minimize watching television and avoid activities that require prolonged focus on nearby objects, such as playing with building blocks or reading comics.
(2) In addition to massage, acupuncture therapy can be used to enhance the treatment effect.
(3) Children with farsightedness can wear glasses.
(4) Alongside treatment, parents can perform orthoptic exercises. Parents can use their index fingers to vertically position them in front of the child's eyes and gradually move them apart, instructing the child to follow the movement of the fingers. Regular practice will naturally yield results.
(5) In cases of long-standing and severe squint that is unresponsive to massage, acupuncture, and eye medication, surgical correction may be considered.
Other Treatments
1. Non-surgical Treatment
The treatment of squint primarily focuses on treating amblyopia to promote good visual development in both eyes, followed by correcting the deviated eye position. Treatment methods for squint include wearing glasses, using eye patches, and orthoptic exercises. Eye patches are the main method for treating amblyopia caused by squint. Eye muscle surgery involves weakening or strengthening one or more of the extraocular muscles of one or both eyes. Prism glasses can be used to correct mild squint. Orthoptic exercises can be used as a supplement before and after surgery.
2. Surgical Treatment
The younger the patient is when undergoing squint surgery, the better the treatment outcome. Squint surgery is not only for correcting eye position and improving appearance, but more importantly, for establishing binocular visual function. The optimal age for surgery is before 6-7 years old. After surgery, binocular vision training is performed to enhance and maintain stable stereo vision.
