Complications of Untreated Squint
Amblyopia is the most important complication of untreated squint, occurring in approximately one-third of children with untreated strabismus and potentially causing permanent vision loss, while retinal detachment is not a complication of the squint itself but rather an extremely rare surgical complication (1 in 10,000-40,000) if strabismus surgery is performed. 1
Understanding the Real Risk: Amblyopia from Untreated Squint
Why Amblyopia Develops with Squint
- Strabismus dramatically increases amblyopia risk by 2.7 to 18 times compared to children without eye misalignment 1
- Approximately one-third of preschool children with esotropia develop amblyopia 1
- The misaligned eye receives poor visual input, causing the brain to suppress that image and leading to permanent vision loss if untreated in early childhood 1
Consequences of Untreated Amblyopia
- With rare exception, amblyopia results in lifelong visual loss if untreated or inadequately treated in early childhood 1
- Vision typically remains reduced even into adulthood, with no spontaneous improvement 1
- The lifelong risk of bilateral visual impairment is approximately doubled for patients with amblyopia 1
- Loss of vision in the good eye later in life (from trauma, retinal disease, or macular degeneration) leaves the person with only the amblyopic eye, resulting in significant visual disability 1
Additional Complications Beyond Amblyopia
- Loss of binocular vision and stereopsis (depth perception), which can impact activities requiring fine depth judgment 1
- Reduced eye-hand coordination and motor skills 1
- Career limitations, as many fields (military, aviation, law enforcement, surgery) require specific visual acuity and stereopsis standards 1
Retinal Detachment: Not a Complication of Squint Itself
Critical Distinction for the Concerned Mother
- Retinal detachment is NOT caused by having a squint 1
- Retinal detachment can only occur as an extremely rare surgical complication if strabismus surgery is performed (1 in 10,000 to 1 in 40,000 cases) 1
- Even when globe perforation occurs during surgery (0.08%-5.1%), most cases have no sequelae, though they do place the patient at higher risk for retinal detachment 1
Reassurance About Surgical Safety
- The risk of sight-threatening complications from strabismus surgery is particularly low 1
- Most surgical complications are minor, self-limited, or treated with topical medications 1
- Severe complications from strabismus surgery are estimated at only 1 in 400, with only 1 in 2,400 resulting in poor outcomes 1
Clinical Recommendation for This Mother
The mother should understand that NOT treating the squint poses a much greater risk to her child's vision than any surgical intervention. The real danger is untreated amblyopia, which will cause permanent vision loss that cannot be reversed later in life. 1 Treatment of amblyopia is most effective in young children, and delaying treatment increases the risk of lifelong visual impairment. 1
Treatment Benefits Far Outweigh Risks
- Timely treatment of amblyopia usually improves visual acuity, may improve binocularity, and decreases the likelihood of visual handicap if vision is lost in the fellow eye later in life 1
- Treatment can include glasses, patching, or eye drops—surgery is not always necessary 1
- Even if surgery is eventually needed for the squint, the benefits of restoring alignment and preventing amblyopia vastly outweigh the minimal surgical risks 1