We offer a School Screening Service, for reception children aged 4-5 who attend schools within the Stoke-on-Trent area. We screen for a number of vision defects including reduced vision, squints or eye movement abnormalities. Your child will be seen by an Orthoptist in school and may be referred to local opticians to check for glasses before seeing an Orthoptist at the hospital or a local community clinic, to monitor their eyes and potentially start treatment.

It is important that we catch eye problems early as vision stops developing around the age of 7-8 years. Spotting conditions early gives a better outcome for treatment.

This includes a Special Schools Service where we routinely visit the special schools within the Stoke-on-Trent and Staffordshire area to provide routine eye tests for children with known eye problems, in their school environment.

As part of your child’s care they may be referred to an optician for additional tests or a glasses update.

Below is a list of specialised paediatric shared care optometrists. Where possible we will select the optician closest to your area, if you would like to go to a specific practice please contact the Orthoptic Department or let your Orthoptist know.

Blythe Bridge

• Gillian Scarisbrick at Gillian E. Scarisbrick Optometrist, 266 Uttoxeter Road, Blythe Bridge, ST11 9LY. Tel: 01782 388355

Biddulph

• Stephen Cotton at S.W.Cotton Optometrist, 75 High Street, Biddulph ST8 6AA. Tel: 01782 519956

Congleton

• Amy Thompson at L. Thompson Optometrists Ltd. Congleton Eye Care Centre, 5-7 West Street, Congleton, Cheshire, CW12 1JN Tel: 01260 270941

Hanley

• Tom Brocklebank or Jon Clements at Glyn Jones Opticians, 36 Trinity Street, Hanley ST1 5LA Tel: 01782 212666

Kidsgrove

• Stephen Cotton at S.W.Cotton Optometrist , 92 Liverpool Road, Kidsgrove, ST7 4EH. Tel: 01782 782385

Leek

• Stewart Townsend at B. Newbold Opticians, 49 St. Edwards St, Leek, Staffordshire ST13 5DN. Tel: 01538 382090

Longton

• Neil Horn or Kirsty Greatbatch at Royles ltd Opticians, 77 The Strand, Longton ST3 2NS. Tel: 01782 313693
• Steve Collier or Judy Lea at Specsavers 36-38 Market Street, Longton ST3 1BS Tel: 01782 337830

Meir

• Irfan Razvi at Razvi Optometrists Ltd, 57-59 Weston Road, Meir, ST3 6AB. Tel: 01782 314673

Newcastle

• Peter Harvey or Mandy Sherratt at Specsavers, Unit 9, Castle Walk, Newcastle, ST5 1AN. Tel: 01782 714444
• John Stevenson at Stevenson Jones Opticians, 6 Friars Street, Newcastle, ST5 2DZ. Tel: 01782 619175

Stoke

• Robert Hanwell at Ernest G Hanwell Ltd., 11 Glebe Street, Stoke, ST4 1HP. Tel: 01782 844105

Tunstall

• Robert Hanwell at Ernest G Hanwell Ltd., 8 Tower Square, Tunstall ST6 5AA. Tel: 01782 838710
• Kirsty Greatbatch at James Herd Opticians, 59 High Street, Tunstall, ST6 5TA. Tel: 01782 837961

As part of your child’s care they may be referred to an optician for additional tests or a glasses update.

Below is a list of specialised paediatric shared care optometrists. Where possible we will select the optician closest to your area, if you would like to go to a specific practice please contact the Orthoptic Department or let your Orthoptist know.

Blythe Bridge

• Gillian Scarisbrick at Gillian E. Scarisbrick Optometrist, 266 Uttoxeter Road, Blythe Bridge, ST11 9LY. Tel: 01782 388355

Biddulph

• Stephen Cotton at S.W.Cotton Optometrist, 75 High Street, Biddulph ST8 6AA. Tel: 01782 519956

Congleton

• Amy Thompson at L. Thompson Optometrists Ltd. Congleton Eye Care Centre, 5-7 West Street, Congleton, Cheshire, CW12 1JN Tel: 01260 270941

Hanley

• Tom Brocklebank or Jon Clements at Glyn Jones Opticians, 36 Trinity Street, Hanley ST1 5LA Tel: 01782 212666

Kidsgrove

• Stephen Cotton at S.W.Cotton Optometrist , 92 Liverpool Road, Kidsgrove, ST7 4EH. Tel: 01782 782385

Leek

• Stewart Townsend at B. Newbold Opticians, 49 St. Edwards St, Leek, Staffordshire ST13 5DN. Tel: 01538 382090

Longton

• Neil Horn or Kirsty Greatbatch at Royles ltd Opticians, 77 The Strand, Longton ST3 2NS. Tel: 01782 313693
• Steve Collier or Judy Lea at Specsavers 36-38 Market Street, Longton ST3 1BS Tel: 01782 337830

Meir

• Irfan Razvi at Razvi Optometrists Ltd, 57-59 Weston Road, Meir, ST3 6AB. Tel: 01782 314673

Newcastle

• Peter Harvey or Mandy Sherratt at Specsavers, Unit 9, Castle Walk, Newcastle, ST5 1AN. Tel: 01782 714444
• John Stevenson at Stevenson Jones Opticians, 6 Friars Street, Newcastle, ST5 2DZ. Tel: 01782 619175

Stoke

• Robert Hanwell at Ernest G Hanwell Ltd., 11 Glebe Street, Stoke, ST4 1HP. Tel: 01782 844105

Tunstall

• Robert Hanwell at Ernest G Hanwell Ltd., 8 Tower Square, Tunstall ST6 5AA. Tel: 01782 838710
• Kirsty Greatbatch at James Herd Opticians, 59 High Street, Tunstall, ST6 5TA. Tel: 01782 837961

Introduction

This leaflet provides you with information on Brown’s Syndrome in children.

It is not meant to replace the discussion between you and your Doctor/Healthcare Professional but may act as a starting point for discussion.  

If after reading it you have any concerns or require further explanation, please discuss this with a member of the Healthcare Team who has been caring for you.

What is Brown’s Syndrome?

Brown’s syndrome is an eye condition characterised by the inability to move the eye upwards and mainly occurs in just one eye, however it can be in both eyes. This may cause the appearance of a squint when looking upwards and in one direction.

In some cases, it may result in your child turning their head slightly to compensate. The eye movement is most restricted when looking upwards and towards the nose.

There is no known link to any other health problems for the syndrome.

 What causes Brown’s Syndrome?

It occurs when the “Superior Oblique Muscle” cannot move normally.  This muscle works on a  pulley system called “The Trochlea”.  The muscle does not pull through the trochlea properly and therefore becomes stuck.

Most people are born with the condition however in very rare cases it can be acquired due to injury or inflammation.

If someone is born with Brown’s syndrome it is thought that the muscle involved is either too short or too tight, or there is a swelling or nodule on the muscle tendon.

What are the treatment options?

Usually, there is no treatment needed.  Often the irregular eye movement is noticed less and less as the patient gets older, grows taller and therefore doesn’t look upwards as often.

Treatment is available however in very rare cases and only if the child has an obvious head posture, it may be possible that other treatment is involved if there are other eye problems, such as a need for glasses.

 Is the condition painful?

Brown’s syndrome is not known to cause any pain or significant discomfort to anyone with the condition.

There are some cases of patients noting a “clicking” sensation due to a nodule on the tendon that is attached to the muscle.  As the muscle moves it “clicks” over the nodule. This is however very rare.

What can I do to help the condition?

Some children have been known to hold their head in a different position so it is worth discussing with their school teacher to ask them to allow your child to sit on the correct side of the classroom.  This puts their eyes in a position away from where the irregular movement takes place.

Introduction

This leaflet provides you with information on a Constant Infantile Esotropia.

It is not meant to replace the discussion between you and your Doctor/Healthcare Professional but may act as a starting point for discussion. 

If after reading it you have any concerns or require further explanation, please discuss this with a member of the Healthcare Team who has been caring for you.

What is a Constant Infantile Esotropia?

A Constant Infantile Esotropia is an inward turn of one eye. This turn may switch to the other eye when your child is looking to the side (Cross Fixation). One eye may also occasionally drift up, for example when looking far away. This is called Dissociated Vertical Deviation (DVD).

Another feature of this squint that may be seen is a slight wobbling of the eyes called Nystagmus. Commonly this type of squint is seen before 6 months.

A squint may be due to a weak muscle, for example the muscle pulling the eye outwards is weak and therefore, the eye turns inwards.

What causes a Constant Infantile Esotropia?

A Constant Infantile Esotropia may be hereditary with a family history of turns in the eye.

 Predisposing factors for this squint include prematurity, hydrocephalus and delayed development.

How can my child’s eyes be affected?

There is the possibility of a child developing Amblyopia “lazy eye”, which is where one eye develops slower than the other and the vision becomes reduced.

This happens because as one eye turns, the brain switches off the signal from that eye and the cells do not develop as they should.

How is this tested?

The Orthoptist will check your child’s eye movements, their vision in either eye and also assess whether your child is using their eyes together (3D vision). 3D vision will not be demonstrated if there is a constant squint present, such as a Constant Esotropia. The size of the squint will also be tested. If present, the wobbling of the eyes (nystagmus) will also be assessed by the Orthoptist.

If older than 6 months, bringing photographs with you of your child’s eyes before they turned 6 months old may aid diagnosis.

Will my child need glasses?

There is a possibility that your child may be longsighted (hypermetropic), in which case glasses will be prescribed. Having a hypermetropic prescription may reduce the size of the squint.

 What are the treatment options?

Children with this type of squint may be examined by one of our Specialist Optometrists (or Opticians) in the community. 

They may be found to be long-sighted (hypermetropic) and are given a pair of glasses. relaxing the muscles. This can reduce the size of the squint.

Surgery may be performed which involves weakening and/or strengthening muscles. The muscle(s) that pull the eye inwards are weakened and the muscle(s) that pull the eye outwards are strengthened.

In the case of an associated lazy eye, patching treatment or eye drops may be used to improve the vision in the lazy eye.

Introduction

This leaflet provides you with information on  Convergence Excess Esotropia.  It is not meant to replace the discussion between you and your Doctor or Healthcare Professional but may act as a starting point for discussion. 

It you have any concerns or require further explanation, after reading it, please discuss this with a member of the Healthcare Team who has been caring for you.

What is a Convergence Excess Esotropia?

This is a squint/strabismus (turn of the eye) that occurs when looking at a near object, but their eyes are straight or almost straight when looking at a distant object.

It happens due to excess focussing called  Accommodation which causes the eyes to turn inwards.

With the corrective glasses the eyes straighten when looking at something in the distance, but the squint is still present looking at something close.

The onset is usually between the ages of 6 months and 5 years.  It can sometimes be up to 10 years.

Convergence Excess Esotropia is caused as above but the squint itself is caused by excess accommodation. 

How can my child’s eyes be affected?

Whilst squints of all kinds are generally more common in children with other health problems, there is no known link with any particular other medical conditions. 

 It is not unusual for a squint to be present independently of any other health problems.

What are the treatment options?

Children with convergence excess esotropia are often trialled in bifocal glasses first to see if this corrects the squint.

If this is unsuccessful, there is the option of surgery to straighten the eyes. 

By making the eyes straight, this allows the eyes to work together, and children can have good 3D vision at all distances.

Will my child always need glasses?

The level of long-sightedness may change as the child gets older.  This is normal but not enough for them to grow out of it completely. 

As the glasses are reducing the size of the squint in the distance, it is beneficial to continue to wear the glasses.

Will my child need surgery?

As bifocals for children take time to get used to, these may be given on a trial basis over a period of time before surgery. 

This trial period will give your child time to see if the bifocal glasses are successful. 

Surgery may only be recommended if bifocal glasses are not suitable, or the squint is very large.

Introduction

This leaflet provides you with information on Duane’s Syndrome in children.

It is not meant to replace the discussion between you and your Doctor/Healthcare Professional but may act as a starting point for discussion.  

If after reading it you have any concerns or require further explanation, please discuss this with a member of the Healthcare Team who has been  caring for you.

What is Duane’s Syndrome?

Duane syndrome is when one or both of the eyes do not move inwards or outwards. This is associated with a change in the opening of the eyelids.

There are 3 different types of Duane Syndrome which are determined by which muscle(s) are affected and how much movement is restricted.  Please ask your Orthoptist if you would like more details.

What causes Duane’s Syndrome?

This is a congenital condition which is present from birth.  It is not often noticed until the child is a little older, it can go unnoticed for a number of years.

There are 6 muscles that control the movement of the eyes. These muscles work by receiving messages from the brain which are sent through nerves to the muscles. 

With Duane’s Syndrome, the nerves are not connected as they should be and therefore send messages to the wrong muscles.

Is there any treatment?

In most cases, no treatment is required other than allowing an abnormal head posture.

Surgery will alter the position of the eyes, but will not remove the Duane’s Syndrome and may be offered if there is:

· A large squint.

· A large head posture (which is affecting the neck muscles/causing pain).

· A large upwards or downwards drift.

Amblyopia “lazy eye” can develop as a result of Duane’s Syndrome. It is where vision in one eye is underdeveloped.

It happens because as one eye turns, the brain switches off the signal from that eye and the cells do not develop as they should. 

In this case patching treatment, or eye drops may be used to try and improve the vision however this will not change the movement of the eyes.

For this condition, there are no exercises than can be done.  This is because it is caused by a mis-wiring of the nerves and muscles from birth.

What will I notice about my child’s eyes?

You will notice the eyes do not move together when they look to the side.

· They cannot look to one or more sides.

 · If they are looking straight ahead, you may not   notice anything.

· One eye drifting upwards or downwards when they look to the side.

· There may be a squint (turn in the eyes) either inwards or outwards. This will depend on the type and severity of Duane’s and usually does not cause any problems.

· Eyelids appear wider and narrower when looking to the side.

· Your child may demonstrate an abnormal head position which allows your child to compensate for where their eye cannot move to  For example, if they cannot move their left eye outwards towards their ear and they may turn their head to the left to allow a greater range of movement.  You should allow your child to use this head position.

What can I do to help the condition?

It is worth discussing with their Nursery to ask them to allow your child to sit on the correct side of the classroom. This puts their eyes in a position away from where the irregular movement takes place.

Introduction

This leaflet provides you with information on Fully Accommodative Esotropia.

It is not meant to replace the discussion between you and your Doctor/Healthcare Professional but may act as a starting point for discussion. 

If after reading it you have any concerns or require further explanation, please discuss this with a member of the Healthcare Team who has been caring for you.

What is Fully Accommodative Esotropia?

This is a type of inwards squint/strabismus (turn of the eye) that happens due to excess focussing, called Accommodation which causes the eyes to turn inwards.

This is a squint that is fully corrected by glasses and allows your child to have 3D vision when they wear the glasses. The onset is usually between the ages of 6 months and 5 years.

What causes Fully Accommodative Esotropia?

As above, the squint itself is caused by excess Accommodation. Often, the condition is hereditary.

Whilst squints of all kinds are generally more common in children with other health problems, there is no known link with any particular other medical conditions.

It is not unusual for a squint to be present independently of any other health problems.

 What are the treatment options?

Children with this type of squint are examined by one of our Specialist Optometrists (or Opticians) in the community where they are usually found to be long-sighted and given a pair of glasses.

The glasses then help the child focus naturally, relaxing the muscles and no longer causing their eyes to turn inwards.

There is normally no other treatment needed for this type of squint.

Will my child always need glasses?

The level of long-sightedness may change as the child gets older, but this is normally not enough for them to grow out of it completely. 

As the glasses are correcting the squint, it is beneficial to continue to wear the glasses.

Will my child need surgery?

No, your child needs their glasses to see and keep normal visual development.

If we corrected the squint without the glasses, the eyes would be too relaxed when your child wore their glasses.  Their eye may then turn out when wearing their glasses.

What if my child’s eye still turns in without the glasses?

The glasses help the squint so if the child takes them off their eye will continue to turn inwards.  This is because they need to over focus without glasses.  When they put the glasses back on their eye will be straight again

What if they turn more now without the glasses?

If this happens, it is because your child has got used to having clear vision with the glasses on. 

When they take the glasses off, they have to put extra focussing work and this can make the squint look more noticeable than it did before they had glasses.

Can the glasses be removed for PE/Swimming?

You can buy prescription goggles and sports glasses if appropriate for your child. 

Children can wear their glasses If it is non-contact sport as this helps them due to their 3D vision when wearing their glasses.

Contact lenses work in the same way as glasses and may also be an option when your child is old enough

Introduction

This leaflet provides you with information on Intermittent Distance Exotropia.

It is not meant to replace the discussion between you and your Doctor/Healthcare Professional but may act as a starting point for discussion. 

If after reading it you have any concerns or require further explanation, please discuss this with a member of the Healthcare Team who has been caring for you.

What is an Intermittent Distance Exotropia?

A type of squint (turn in the eye). This is where one eye turns outwards, mostly when looking at objects in the distance.

The eyes are straighter when looking at an object at near reading. 

Your child will have 3D vision when looking at near objects.

What causes Intermittent Distance Exotropia?

Any squint is caused by an imbalance in the eye muscles.  If there is a family history of squints this can make it more likely for your child to develop a squint.

Certain medical conditions, trauma and prematurity may make it more likely for your child to develop a squint.

How can Intermittent Distant Exotropia affect my child’s eyes?

Children do not usually experience any symptoms, even when their eye is turning.  This is due to the child’s eyes being adaptable.  When the eye turns, the brain ignores that eye (suppression) to prevent double vision.

You may notice the squint more when your child is unwell, tired, in bright sunlight, daydreaming and sometimes when in the car.

You may notice your child rubbing their eye, closing one eye, particularly in bright sunlight.  This is a normal response to this type of squint as your child tries to control their eyes.

It is useful to wear sunglasses in bright sunlight but there is no other cause for concern.  It is worth mentioning this to your Orthoptist if your child does this.

Will my child need glasses?

Having this type of squint does not mean your child will need glasses.  If there is a history of family having to wear glasses then your child may be more likely to need them.

Depending on the type of prescription, (short-sighted) glasses may help to control and reduce the size of the squint.

If your child does not require glasses for their vision, then glasses will not help your child’s squint.

What are the treatment options?

If the squint is well controlled and good 3D vision is maintained, no treatment is necessary.  If you notice your child’s eye drifting outwards, we will monitor for a period of time to check the control.

Surgery can reduce the size of the squint by re-adjusting the position of the eyes and may be suggested if:

· You notice the squint more than 50% of waking hours and it is causing problems.

· There are concerns about the way the squint looks (Cosmesis).

· The squint worsens and the eyes start to turn when looking at near objects, as this will disrupt their 3D vision.

· Your child starts to notice double vision, although this is rare.

Will the squint always be there?

There will always be a squint, but the amount you notice may vary.  Some children will never need any treatment on their eyes and their squint never affects daily life.

There is nothing to predict how your child’s squint will change in the future.

Introduction

This leaflet provides you with information on Lazy Eye.

It is not meant to replace the discussion between you and your Doctor/Healthcare Professional but may act as a starting point for discussion.  

If after reading it you have any concerns or require further explanation, please discuss this with a member of the Healthcare Team who has been caring for you.

What is a Lazy Eye?

A lazy eye or amblyopia occurs when the sight of one or both eyes is underdeveloped causing reduced vision

What causes amblyopia?

· A squint (a turn in the eye) is the most common  reason for one eye to be amblyopic.

· Amblyopia can also occur when one or both eyes are  longsighted, shortsighted or have astigmatism.

· If there is an obstruction to light reaching the back of the eye such as cataract or scarring

How is Amblyopia treated?

Amblyopia can be treated with glasses and or as well as occlusion (patching/drops) therapy.

Glasses can help some children by letting the eye focus properly.  In addition, covering or blurring of one eye is often needed.  A medically prescribed atropine eye drop can be used to blur the vision in the good eye, or a patch can be used to cover the good eye. 

Can my child have amblyopia treatment at any age?

Vision is most adaptable to change during the critical period which is up until age 8 years. There may be some opportunity for vision to improve beyond age 8 years, but this is less likely.

Does the occlusion (patching/drops) help my child’s sight?

· If the child uses the eye more, the sight should improve as it is the lack of proper use that has caused it to be lazy.

· Covering or blurring the good eye should make the lazy eye work harder.

· If the child needs glasses then these should be worn at the same time as patching or eye drops.

Should my child do anything different when being occluded?

As the atropine drops give a constant blur, there is no one activity better than another if your child likes to watch TV, they may need to sit closer to see properly.

If your child’s sight is very poor it is best to let them play with things that are big and bright so that they can be seen more easily.

Other activities that can encourage the eye to work harder whilst wearing a patch for a set time are reading, drawing, playing with small toys or computer games.

 How long will the occlusion take?

This varies from child to child and depends on their age and how long the eye has been lazy.

The Orthoptist will monitor progress regularly and will develop a treatment plan to suit you and the visual needs of your child.

Does occlusion therapy really work?

Occlusion can only work if your child wears the patch or puts the eye drops in as instructed.  It can only help your child’s lazy eye and may not improve the squint.  Squints are treated with glasses and/or surgery.

Will it get better on its own?

No. If left untreated, the child may have permanent damage to their sight which cannot be corrected when they are older.

Tips

· Encourage.

· Keep trying - despite opposition.

· Ask for support from others.

· Make it fun.

· Keep them busy.

· Reward good behavior.

Introduction

This leaflet provides you with information on Marcus Gunn Jaw Winking Syndrome.

It is not meant to replace the discussion between you and your Doctor/Healthcare Professional but may act as a starting point for discussion.  

If after reading it you have any concerns or require further explanation, please discuss this with a member of the Healthcare Team who has been caring for you.

What is Marcus Gunn Jaw Winking Syndrome?

This is a condition affecting one eye, where the eyelid lifts when the jaw is moved from side to side.

It is usually noticed when sucking or chewing but can sometimes be seen just by opening and closing the mouth.

There can be an associated droopy upper eyelid (ptosis) when there is no movement of the jaw.  This varies in the amount of droopiness that is noticed.

What causes Marcus Gunn Jaw Winking Syndrome?

The nerves that control the eyelid muscles and jaw muscles are not connected properly.

 There is a mis-wiring of the nerves which results in an abnormal connection causing them to move together.

It is congenital – your child is born with this condition.

Is there any treatment?

There are no treatment options for this condition as it is not possible to re-wire the nerves and connections that have formed abnormally.

It does not normally affect their daily lives and often becomes a “party-trick” as they get older.

Treatment can be offered for associated problems.

If there is reduced vision in one eye, patching treatment/eye drops may be used to try and improve the vision.

If there is a significant droopy eyelid, then surgery can sometimes be offered to lift the lid.

What will I notice?

You may notice in one eye, the upper eyelid flicker open and closed when your child is eating/drinking/smiling.

It can look like your child is repeatedly winking.

It is often most noticeable when babies are feeding; however, it can go unnoticed until your child is slightly older.

Is this associated with other health problems?

Depending on the severity of the droopy lid, there can be some reduced vision in that eye if the eyelid is covering the pupil.

There is no increased need for glasses/squint (turn in the eyes) in these children compared to other children.

Introduction

This leaflet provides you with information on Nystagmus.  It is not meant to replace the discussion between you and your Doctor/Healthcare Professional but may act as a starting point for discussion.  

If after reading it you have any concerns or require further explanation, please discuss this with a member of the Healthcare Team who has been caring for you.

What is Nystagmus?

It is involuntary movements of the eyes.  The eyes appear to wobble/shake from side to side (but can move up and down or circular).  It is often described as “shaky, jerky or wobbly eyes”.

It is associated with cataracts, ocular albinism, abnormality of the optic nerve, retina (back of the eye)

Nystagmus can also occur in children with learning disabilities or other medical conditions.  Sometimes no cause/association can be found.

What causes Nystagmus?

There are two types of Nystagmus:

Congenital Nystagmus develops within the first few months of life and occurs when the part of the brain that controls eye movements does not develop properly.

Acquired Nystagmus develops later in life because of damage to the area of the brain that controls eye movements.  It can also occur after an illness or following an injury or stroke, or it can be inherited.

How can Nystagmus affect my eyes?

Some children with Nystagmus will have no problems with their vision, or only have slight reduced vision. Other children may have very reduced vision and struggle to see things.  This will depend on the cause and type of Nystagmus.

Your child may need longer to see or read things due to the constant movement of their eyes.  It is important to allow them extra time and to inform nursery or school of this condition.

Children may also find it easier to bring things closer to see as the wobble often lessens as you get closer.

Children with Congenital Nystagmus adapt from a very young age and can manage well as they get older with their learnt coping strategies.

What are the treatment options?

There is no treatment for Nystagmus.  Children will have an eye test to see if there is any associated long or short-sightedness.

If a need for glasses is found this may help improve the vision slightly but this is not a cure.

What will I notice?

Your child’s eyes may wobble, and they may also want to hold their head in a certain position.  This is called a null point and is where there is little to no movement of the eyes.  It allows your child to achieve their best level of vision.

Is there any specialist help available?

Once Nystagmus has been diagnosed, you will have the option to have your child referred to the Visual Impairment Team (VIT) who can provide extra support and help at home, nursery and schools. 

The VIP Team can provide valuable help in a child’s education, and they can offer advice on other aspects of your child’s daily life, such as advising a particular place in the classroom for them to sit to get the best vision. This will depend on a child’s null point.

Dependent on the child’s level of vision, they may qualify to be registered sight impaired.

Introduction

This leaflet provides you with information on Partially Accommodative Esotropia.

It is not meant to replace the discussion between you and your Doctor/Healthcare Professional but may act as a starting point for discussion. 

If after reading it you have any concerns or require further explanation, please discuss this with a member of the Healthcare Team who has been caring for you.

What is Partially Accommodative Esotropia?

This is a type of inwards squint/strabismus (turn of the eye) that happens due to excess focussing called Accommodation, which causes the eyes to turn inwards.

When the long-sighted glasses are worn, the squint is reduced in appearance and size but is not fully straightened or corrected.  The onset is usually between the ages of 6 months and 5 years.

What causes Partially Accommodative Esotropia?

As above, the squint itself is caused by excess Accommodation. 

Whilst squints of all kinds are generally more common in children with other health problems, there is no known link with any particular other medical conditions.

It is not unusual for a squint to be present independently of any other health problems

How can my child’s eyes be affected?

There is the possibility of a child developing Amblyopia “lazy eye”, which is where one eye develops slower than the other and the vision becomes reduced.

This happens because as one eye turns, the brain switches off the signal from that eye and the cells do not develop as they should.

Will my child need glasses?

It is likely because long-sightedness is associated with this type of squint and the glasses will normally improve the squint.  This may change as the child gets older, but it is unlikely that they will grow out of it.

If the glasses are reducing the size of the squint, it is beneficial to continue to wear the glasses.

What are the treatment options?

Children with this type of squint are examined by one of our Specialist Optometrists (or Opticians) in the community. 

They are usually found to be long-sighted and are given a pair of glasses to help the child focus naturally, relaxing the muscles.  This can reduce the size of the squint and is often enough, so no further treatment is needed.

In the case of an associated lazy eye, patching treatment or a course of eye drops may be used to improve the vision in the lazy eye.

Will my child need surgery?

This depends on the size of the squint and sometimes glasses correct it enough for it not to be noticeable and so no surgery is needed.

Introduction

This leaflet provides you with information on Pseudo-squint/Pseudo-strabismus.

It is not meant to replace the discussion between you and your Doctor/Healthcare Professional but may act as a starting point for discussion. 

If after reading it you have any concerns or require further explanation, please discuss this with a member of the Healthcare Team who has been caring for you.

What is a Pseudo-squint?

A pseudo-squint is the false appearance of a squint. This is where it looks like one or both of your child’s eyes turn inwards or outwards, but they are actually straight.

This is particularly noticeable on photographs where you are looking at your child on an angle. It is often most noticeable from birth up to 12 months, but it can be noticeable beyond this.

This is different to a squint where one eye does turn inwards/outwards due to a weak muscle or the need for glasses.

What causes a Pseudo-squint?

In babies and young children, the bridge of their nose is often wide and flat, which can result in folds of skin across the inner corners of the eyes (epicanthic folds) that cover part of the inner white part of the eye.

 This appearance of noticing more of the white part on eye compared to the other can give the optical illusion that one eye is turning inwards.

Other causes may include your child’s eyes being close together or far apart, their eye/eyelid shape or heterochromia (different coloured eyes).

How is this tested?

The orthoptist will look at the light reflections in both your child’s eyes to make sure they are symmetrical.

Your child’s vision will be checked in either eye and assessed whether your child is using their eyes together (3D vision).

3D vision is only demonstrated when there is no squint present.

Will my child need glasses?

As the appearance of the pseudo-squint will reduce as your child gets older, it is unlikely your child will need glasses. Glasses do not help for a pseudo-squint unless they are required for your child’s vision.

What are the treatment options?

There is no treatment required for a pseudo-squint. As your child naturally grows and the bridge of the nose develops and fully forms, the skin folds in the corners of the eye will become less prominent.

A child with a pseudo-squint may develop a true squint as they get older however it is more common in early childhood.

If you notice a new squint or a change in the pseudo-squint, contact the department or seek a new referral from your health visitor/GP or Optician.

Introduction

This leaflet provides you with information regarding your child’s referral to the POSC optometrist.

The POSC optometrists are our hospital approved specialists and are competent in testing children.

It is not meant to replace the discussion between you and your Doctor/Healthcare Professional but may act as a starting point for discussion.  

If after reading it you have any concerns or require further explanation, please discuss this with a member of the Healthcare Team who has been caring for you.

What will happen at the appointment?

On this visit your child will need drops in their eyes (unless specified otherwise by your Orthoptist) – this is to enable the optometrist to check for glasses and assess the health of the eyes. The optometrist will put the drops in on arrival at the opticians; these can take up to 40 minutes to work.

The drops will temporarily enlarge the pupils (dilate) and relax the muscles in their eyes. This makes it easier for your child’s eyes to be examined. The drops cause blurred vision and sensitivity to light. These effects usually clear within 24 hours but can last for up to 2 days.

Please bear this in mind when crossing the road with your child, or if they are returning to school after the eye examination.

It is important that you attend the appointment with the optometrist. Failure to attend may result in you being discharged from the Orthoptic Department.

If you are unable to attend the appointment, please contact the optometrist to rearrange the appointment.

What will happen after the appointment?

Any necessary glasses will need to be prescribed.

These may be obtained from the optometrist, who has tested your child’s eyes, or you may take the prescription to another optometrist and have the glasses made up there.

After seeing the optometrist your child will need to be seen again by the orthoptist, unless stated otherwise by the optometrist. We will send you an appointment in due course.

Glasses should be worn full-time, unless stated otherwise by the optometrist/Orthoptist.

What are the side effects of the drops?

The drops make your eyes sensitive to light and cause blurred vision. These effects usually clear within 24 hours but can last for up to 2 days.

Please bear this in mind when crossing the road with your child, or if they are returning to school after the eye examination.

If an allergic reaction occurs or if an unusual dose is given, there may be:

· An increased redness/flushing and/or dryness of the skin.

· Red watery eyes with possible white mucus discharge.

 · Red watery eyes with possible white mucus discharge.

· Changes to sense of touch/vision.

· Heart beat irregularities.

· Problems with balance.

· Rash.

· Fever.

· Changes to behaviour.

· Confusion/drowsiness/hallucination.

Other side effects may include:

· Temporary irritation/stinging.

· Increased pressure within the eye.

If you have any concerns immediately following the use of the drops please speak to your optometrist.

Introduction

This leaflet provides you with information on Squint Surgery.

It is not meant to replace the discussion between you and your Doctor/Healthcare Professional but may act as a starting point for discussion.  

If after reading it you have any concerns or require further explanation, please discuss this with a member of the Healthcare Team who has been caring for you.

Why do I need Squint Surgery?

This will vary between patients. Usually, it is to improve the alignment of the eyes. This can be helpful for psycho-social (cosmetic) reasons.

It may also reduce double vision for some patients.

What is Squint Surgery?

Squint surgery is a very common operation usually performed under general anaesthetic.

It is nearly always a day case procedure, and you will not need to stay in overnight.

It involves adjusting the eye movement muscles on the outside of the eye to strengthen or weaken them.

What is involved in Squint Surgery?

· Squint surgery involves shortening the muscle or changing where it is attached to the eye.

· The surgeon is able to access them without removing the eye from its eye socket, as the  muscles are quite near to the front of the eye.

· Stitches are used to reattach the muscles in their new positions. These dissolve over time and do not need to be removed.

What are the different kinds of surgery?

Non-adjustable surgery

This is usually carried out under general anaesthetic (when you are asleep).  It takes around 1 hour (depending on how many muscles are being operated on).

Adjustable surgery

The ophthalmologist will discuss with you if they think an adjustable operation would be best for you. This can be useful for some people especially if there is a high risk of double vision or if you have had squint surgery before.

During the adjustable surgery, 1 suture (stitch) is made which is not completely tied off.  This allows for some adjustment when you have woken up from the main surgery.  

The adjustment takes place on the ward or in the eye clinic the morning after your operation.

If you wear glasses, you will need to bring them with you for the adjustment.

The Doctor will use anaesthetic eye drops for the adjustment. 

What happens before surgery?

· You will need to see the orthoptists on a number of occasions to take measurements of the position and movements of your eyes. This will allow the surgeon to plan how much to move the muscles.

· The orthoptist will assess the risk of double vision after the surgery.

· You will meet with the consultant to discuss the risks and benefits of the surgery so you can make an informed decision about going ahead.

· Before having a general anaesthetic you need to have a pre-operation assessment to make sure you are fit for surgery and the general anaesthetic. 

How do I prepare for surgery?

· You can eat up to 6 hours before your operation.

· You can drink clear fluids up to 2 hours before your operation.

· You will need to arrive in the morning at 11.30am, although the operation may not take place until the afternoon.

· You can usually go home the same day as your surgery.

· You will be given eye drops with instructions before you go home and a plan regarding follow-up.

Does the surgery cure the squint?

· Most people feel some improvement in their squint after surgery, however a squint may not be completely corrected by one operation.

· In some cases, your eyes may look straighter just after the surgery.

· Some people may need another operation   during their lifetime.

The operation does not change your vision, such as a lazy eye or the need for glasses.

What are the risks of the operation? 

Squint surgery is generally a safe operation, however, as with any operation, complications can occur. These may include:

Under and Overcorrection

· Squint surgery results are not always completely predictable and therefore the squint you had before the operation may still be present (under correction).

· There may be a squint in the opposite direction after the operation (overcorrection). These problems may require more surgery.

Double vision

· You may have double vision after surgery as your brain gets used to the new position of your eyes.  This is common and often settles in a few days or weeks.  For some people, it may take months to improve.

· It is rare for double vision to be permanent after surgery.  If this does happen, more treatment will be required.

· If you had double vision before the surgery it may be different after the operation.  You will be assessed by the Orthoptist to find what will work best to reduce any double vision. 

Allergy

A mild allergic reaction to the drops that are given after the operation may cause itchy, irritated eyes and red or puffy eyelids.  This usually settles quickly once the drops are finished.

Stiches

· It is normal for the eye to feel slightly gritty before the dissolvable stitches have been absorbed.  This takes a few weeks to settle down.  

· An infection and cyst may develop around the stitches, therefore you should not swim in the first 4 weeks after the surgery. 

· A cyst normally settles when the stitches are absorbed  Occasionally further surgery is needed to remove the cyst.

Redness

· Redness in the eye which should be reducing and fade in time, may take up to 3 months to go away. 

· Occasionally the eye does not return completely to its normal colour.  This can happen if you have had more than 1 squint surgery.

Scarring

· Occasionally, visible scars may remain, especially with repeat operations.

· The scarring on the conjunctiva (a clear layer that covers the white of the eye), should reduce over a period of 3 months after surgery.

Lost or slipped muscle

· The eye movements can be affected, as the muscle can no longer pull properly.  This is caused by one of the eye muscles slipping back from its new position on the eye.  This can happen either during or shortly after the operation.

· More surgery may be required if the eye muscle slips back from its new position and it is not possible to completely correct a slipped muscle. This is why you are advised not to rub your eye in the first few weeks after surgery.

Needle penetration

· A small hole in the eye may occur and sight may be affected depending on where the hole is.  This can happen if the stitches are too deep or the white of the eye is thin. Treatment is antibiotics or laser treatment to seal the hole.

· The needle goes in too far.  This can occur if the white of your eye is thin due to squint surgery and can lead to sight loss.

· Infection or retinal detachment (inner layer of the eye), could occur due to previous surgery.  If the eye is penetrated, this can lead to loss of sight.

Anterior Segment Ischaemia (poor blood supply to the front structures of the eye).

· The blood supply to the front structures of the eye can be reduced following surgery.  These structures include the muscles that allow you to change focus and move your pupil. 

· If this occurs, the pupil may be large and vision may be blurred due to the reduction of the blood supply.  Only usually occurs in patients who have had multiple surgeries. 

Infection

Infection resulting in loss of the eye or vision. Very rare. 

Loss of vision

Loss of vision in the eye being operated on following squint surgery. 

What happens after surgery?

· Your eye (or eyes) will be swollen, red and sore.

· It is likely your vision might feel blurry too. This is normal.

· You should start using your drops the morning after your operation and use painkillers (such as paracetamol and ibuprofen) if you feel you need to. The pain usually reduces within a few days.

· The redness and discomfort may be present for up to 3 months, especially if you have had  surgery before or you had adjustable stitches.

· Remember to not rub your eyes.  Continue using your glasses as normal but avoid contact lens wear until you have seen the Doctor.

· Use cooled boiled water and a clean tissue or cotton wool to clean any stickiness from your eyes if necessary.

· Avoid water from your bath or shower from getting into your eyes for the first week. You are advised not to swim for 4 weeks.

Introduction

This leaflet provides you with information on Squints.

It is not meant to replace the discussion between you and your Doctor/Healthcare Professional but may act as a starting point for discussion.  

If after reading it you have any concerns or require further explanation, please discuss this with a  member of the Healthcare Team who has been caring for you.

What is a Squint?

A squint occurs when an eye turns and stops working with the other eye. 

Most commonly the eye may turn towards the nose or turn out and more rarely up or down 

What causes a squint?

· Can be caused by long sightedness.

· If the child needs glasses. The strain made by the child to see without the glasses causes the eye to turn in.

· There may be no obvious reason but there is  often a history of glasses and/or squint in the family.

How is a Squint treated?

There are treatments to improve the child’s vision:

Glasses

This will improve some types of squint.

Surgery.                             

This may be required to improve some squints.

If the vision in the squinting eye is poor, temporary patching of the good eye may be necessary.  This will help to improve the vision.

Will my child grow out of a squint?

No, although some squints improve as the child gets older.

Who will treat my child’s eyes?

· The Consultant Ophthalmologist has overall responsibility for your child’s general eye care.

· The Orthoptist specializes in the treatment of squints and children’s eye development and works closely with the Ophthalmologist.

· The Optician/Optometrist will test your child for glasses yearly or more frequently if necessary, and advise you when changes are needed

How long does treatment take?

This varies from patient to patient.  The only general rule is that with a squint a better result is easier to achieve if treatment is started at an early age.

How do I find out about my child’s eye condition?

Ask any of the eye care professionals dealing with your child’s eye condition.

Every case is different and with your child’s record to hand, it is easier to answer any specific questions you may have.

Introduction

This leaflet provides you with information on wearing glasses.

It is not meant to replace the discussion between you and your Doctor/Healthcare Professional but may act as a starting point for discussion.  

If after reading it you have any concerns or require further explanation, please discuss this with a member of the Healthcare Team who has been caring for you.

How does the Doctor/Optician know that my child needs glasses?

Eye drops are prescribed to enlarge the pupil which helps the doctor/optician to be able to see the back of the eye using a test called ‘a refraction’.  This is usually done once a year.

This involves moving a line of light with a torch like instrument in front of the eye which helps the doctor/optician to judge what strength of glasses are needed.

Will my child always need to wear glasses?

The use of glasses may change as your child gets older and this will be monitored by the orthoptist.

It will depend on:

· The age of the child.

· The strength of the glasses.

· If they are also required as part of the treatment of squint or lazy eye.

Should my child wear their glasses all day?

· Yes in most cases.  If the glasses are not needed full time, your orthoptist will tell you.

· Some schools require children to remove glasses during activities for the child’s safety.  It is not advisable if your child has poor vision without wearing glasses so it may be better that the glasses are left on.  The orthoptist will give you advice on this.

· Some young children need lots of encouragement to wear their glasses full-time and you may need time to build up the time gradually.

· Glasses are prescribed to help your child achieve the best possible vision

What if my child claims to see better without glasses?

This is quite a common complaint in the early days of wearing glasses. Initially the glasses may not help the child very much as it can take time for their eyes to adapt to the glasses.

This is a very important stage of the treatment so please keep trying.  Contact the orthoptist if you have any concerns.

Will my child become dependent on glasses?

No, glasses do not weaken the eyes in any way.  Your child may be reluctant to be without their glasses because they can see so much better with them on.

What is long sight/short sight/astigmatism?

Long sight- (Hypermetropia) is caused by the eye being too short, so that the rays of light entering the eye focus behind the retina (back of the eye) instead of on the retina.  Long sighted children may have reduced vision for near and distance.

Short sight- (Myopia) is caused by the eye being too long, so that the rays of light entering the eye focus in front of the retina instead of on the retina. Short sighted children may have reduced vision for near but tends to affect distance vision more.

Astigmatism– In addition to being long or short sighted, your child’s eyes may be an irregular shape and as a result of this the vision is affected at all distances.

How do I find out about my child’s eyesight?

Ask any of the eye care professionals involved with your child’s treatment and they will be able to answer any specific questions you may have.