Treating little Lady Louise Windsor's squint has combated risk to her sight

• Lady Louise Windsor, aged ten, has had an eye problem corrected
• Correcting a squint - known as a lazy eye - can save a child's sight

By DR ELLIE CANNON

Published: 17:00 EST, 18 January 2014 | Updated: 17:00 EST, 18 January 2014

I was so pleased that  Lady Louise Windsor, the daughter of Prince Edward  and the Countess of Wessex, appears to have had what  was a fairly dramatic squint corrected.

With conditions like this, some people have a tendency to make unfair assumptions about someone’s character based purely on appearance.

The family have chosen not  to reveal the details of ten-year-old Lady Louise’s treatment, and whether she had surgery  is not known.

Before and after: Lady Louise Windsor in June 2013, left, and right, attenidng the Christmas Meeting at Ascot Racecourse in December after her correction

Although there are many options for treating a squint,  an operation shouldn’t be shied away from – it’s not simply a cosmetic treatment, but one that saves sight.

Can’t some people with  a squint see just fine?

People can learn to live with varying degrees of vision  and sight loss. But this condition, if untreated, usually leads to deterioration in the capabilities  of the affected eye, which is why treatment at a young age is recommended.

A squint – the medical term is strabismus – is when the eyes do not align in their movements. One eye will look straight ahead, while the other turns inwards, outwards, upwards or downwards.

As the eyes are focusing on different things, the brain ignores the signals from one eye to avoid ‘seeing double’.

It’s this eye that becomes  weak, and eventually vision in it starts to worsen.

The problem is often  something a child is born with, evident from birth, and it is due  to weaknesses in the muscles that surround the eye. A child is more at risk of a squint if they are born prematurely, like Lady Louise, or have a family history  of them.

Saving grace: The squint, also known as a lazy eye, prevented Lady Louise, pictured before her operation with her mother Sophie Countess of Wessex, from seeing straight

Is surgery the only sure way of correcting it?

No, it’s usually offered only once other options have proved ineffective. Glasses are one of the most common treatments for squints and are used firstly to correct any vision problem. But this can also correct the squint itself. Injections of Botox have now started to be used on the NHS for squints: this is injected into the eye muscles and allows them to realign.

The younger the child, the higher the chances are of correction and preserving optimal vision.

What about eye patches  – are they helpful?

Patching is used for children with squints but is not a treatment. It can save the child’s vision, but doesn’t affect the cosmetic appearance.

When a child has a squint, one eye becomes ‘lazy’ and loses vision – we call this amblyopia. This weaker eye points in the wrong direction and so doesn’t get all the visual stimuli the other one does. An eye needs these stimuli to develop proper visual pathways to the brain.

A lazy eye will therefore not have proper development and  the child relies more and more  on the good eye.

Patching is used to cover the good eye, which forces reliance on the weaker eye, and so it can start to develop proper visual pathways. The earlier this is done the better – often from age two.  If left untreated beyond the age of seven, it is usually too late to acquire full vision in the lazy eye.

What does the  operation involve?

Eye movements are controlled by a set of muscles, and corrective surgery moves these muscles to a new position to straighten the eyes. There is no scar – just a few dissolvable stitches are left inside the eye socket. It can be sore for a few days but recovery involves using the eyes as soon as the patient feels comfortable – to read, for example – so that they get used to working again.

Is surgery always successful?

Squint surgery is relatively straightforward, but a second operation for further alignment of the eyes is not uncommon. Estimates show that about one in five goes on to have a second operation.

Is there a cut-off point –  can adults have squints corrected if they didn’t as children?

The operation is possible with a good chance of an acceptable cosmetic result,  but it would be too late to correct a ‘lazy’ eye for visual acuity. As a rule, the earlier someone is treated, the better the outcome.

Concerns about a child’s eyes should be a raised with a GP who can refer  to an orthoptist for assessment of the  eye muscles.