Principles of management of non-paralytic squint

Non-paralytic squint can be managed on several fronts, best remembered by the fact that they all start with an o:

• optical measures:
  • prescription of spectacles to overcome refractive errors, principally in squint caused by long sight
  • this sharpens retinal images and decreases accommodative convergence
    
    
• orthoptic exercises:
  • performed best by orthoptists where the patient is encouraged to fuse images with the lazy eye
    
    
• occlusion of the better-seeing eye:
  • to force the squinting amblyopic eye to take up fixation and thus improve its level of visual acuity
  • this works best if started at an early age
  • usually requires many hours each day over weeks or months
    
    
• operative correction of the squint