Eye alignment for children and adults, alongside eyelid, tear-duct and orbital surgery. These are the procedures where function and appearance are inseparable — a drooping lid blocks vision and changes a face, and both deserve attention.
Squint, or strabismus, is misalignment of the two eyes — one may turn inward, outward, upward or downward while the other fixes on the target. It affects around two to four per cent of children. In a developing child the consequence is not merely cosmetic: the brain suppresses the image from the deviating eye to avoid double vision, and that suppressed eye fails to develop normal sight. This is amblyopia, or lazy eye, and after roughly age eight it becomes very difficult to reverse.
The single most damaging myth about childhood squint is that the child will grow out of it. True intermittent squints in early infancy sometimes settle, but a constant squint after four to six months of age needs assessment, and waiting costs the child vision that cannot be recovered later. Many squints, particularly in hypermetropic children, correct completely with spectacles alone — no surgery at all.
Oculoplasty covers the structures around the eye rather than the eye itself: the eyelids, the tear drainage system, the orbit and the socket. A drooping upper lid can block the visual axis. An inward-turning lid scrapes lashes against the cornea with every blink. A blocked tear duct means a lifetime of wiping a watering eye and recurrent infections.
These procedures sit at the meeting point of function and appearance, and both matter. An eyelid operation that restores the visual field but leaves an asymmetric lid crease has only half succeeded.
Some of these are urgent in children because of the narrow window for visual development:
Esotropia, exotropia and vertical deviations in children. Assessment covers cycloplegic refraction, alignment measurement, binocular vision testing and a dilated fundus examination — because occasionally a squint is the presenting sign of a serious retinal problem, which is why the retina must always be checked.
Long-standing childhood squint that was never corrected, or new-onset deviation from nerve palsy, thyroid eye disease or trauma. Correction in adults improves alignment, restores binocular function in many cases, and has a documented impact on employment and social confidence.
Reduced vision in a structurally normal eye because the brain suppressed its image during development. Treated with correct spectacles plus patching or atropine penalisation of the stronger eye. Results are excellent when started early and diminish sharply after age eight.
Congenital or acquired weakness of the lid-lifting muscle. In children it can cause amblyopia by obstructing the visual axis; in adults it narrows the visual field and creates a chronically tired appearance. Corrected by levator resection or a frontalis sling depending on muscle function.
A blocked meibomian gland forming a firm lump, or an acutely infected lash follicle. Many settle with warm compresses and lid hygiene; persistent chalazia are removed through a small procedure from the inner lid surface, leaving no visible scar.
The eyelid margin turning inward so lashes abrade the cornea, or turning outward so the eye waters and the exposed surface dries. Both are corrected with lid-tightening procedures under local anaesthesia.
Constant watering with recurrent infection. In infants, probing and syringing is usually sufficient. In adults, dacryocystorhinostomy creates a new drainage passage into the nose, either externally or endoscopically.
Removal of excess upper eyelid skin and herniated fat. Functional when the overhang genuinely obstructs the superior visual field, and cosmetic when it does not — and the distinction is made honestly.
Bulging eyes, lid retraction, double vision and, in severe cases, optic nerve compression from thyroid disease. Requires coordinated management with your endocrinologist, since eye activity tracks thyroid control.
Squint and oculoplasty share a principle: measure carefully before intervening, because the surgical plan is derived from the measurements.
Vision in each eye separately, cycloplegic refraction in children to reveal the full hypermetropic error, slit-lamp examination and a dilated fundus check to exclude an underlying retinal cause.
The angle of deviation is measured in each direction of gaze with prisms and cover testing. Binocular single vision and stereopsis are assessed. These measurements determine which muscles are operated on and by how many millimetres.
In accommodative squint, full hypermetropic correction alone often straightens the eyes completely. Where amblyopia exists, patching is undertaken before surgery — the aim is a straight eye that also sees well, not merely a straight eye.
In selected small or recent-onset deviations, botulinum toxin injection into an extraocular muscle can realign the eyes temporarily and helps predict the response to surgery.
The extraocular muscles are strengthened or weakened by recession or resection through a small incision in the conjunctiva. The eyeball is never removed from the socket, contrary to a persistent and understandably alarming myth. Children are operated under general anaesthesia, most adults under local, as day-care.
Chalazion incision, ptosis correction, entropion and ectropion repair and blepharoplasty are typically performed under local anaesthesia in a minor operating theatre, taking twenty to sixty minutes. Sutures are removed at about one week.
Infant probing and syringing takes minutes under brief anaesthesia. Adult dacryocystorhinostomy takes around an hour, sometimes with a silicone tube left in place for a few months to keep the new passage open.
Alignment is reassessed at one week, six weeks and three months. Squint surgery is a fine adjustment of a living system, and a proportion of patients require a second procedure for residual deviation — this is discussed openly beforehand.
After squint surgery the white of the eye is markedly red for two to four weeks, which looks far worse than it feels. Mild ache on eye movement for a few days is normal. Children are usually back at school within a week.
Eyelid surgery produces bruising and swelling that peaks at forty-eight hours and settles substantially by two weeks, though the final contour continues refining for two to three months.
Functional procedures are generally covered by insurance; purely cosmetic ones are not. Indicative ranges for Delhi NCR:
Indicative ranges for Delhi NCR as a guide only. Your written estimate is given after examination and depends on the technology, lens or drug used, hospital tariff and insurance cover. Most procedures are supported by cashless insurance at Max hospitals.
Retina, cataract, glaucoma and LASIK evaluations at Max Smart Saket, Max Panchsheel Park and Synergy Eye Care.
