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A squint, medically known as strabismus, is one of the most common eye conditions in children, affecting around 1 in 20 children under the age of 5. It occurs when the eyes do not point in the same direction, with one eye turning inwards, outwards, upwards or downwards. A squint is not just a cosmetic concern: if left untreated, it can lead to amblyopia (lazy eye), permanently reduced vision in the affected eye, and loss of depth perception. It is essential to diagnose a squint early so that treatment can be started, ideally before a child starts school. At Clinica London, our paediatric ophthalmologist and orthoptic team work together to assess, diagnose and treat childhood squint with expert, personalised care. You do not need a GP referral to book a consultation.
Your child develops a sudden squint, especially if accompanied by double vision, headache, or any change in their general health. While most childhood squints are developmental, a squint that appears suddenly can occasionally indicate a neurological cause that requires investigation.
If your child develops a sudden squint alongside any of the signs above, contact us straight away for an urgent assessment. Same-day appointments are often available, and you will always be seen for urgent eye care concerns within 36 hours (Mon–Fri, 9am–5pm). You can visit your local accident and emergency department out of hours. Find out more about urgent eye care
No referral is needed to book an appointment at Clinica London. If your GP, health visitor or school nurse has raised a concern about your child's eyes, we would recommend bringing any letters or referral notes to the appointment. We will write to your GP following the consultation with a full clinical summary.
Book a children's squint assessment →A squint (strabismus) is a misalignment of the eyes: one eye points in a different direction from the other. It may be present all the time, or come and go. It can affect one eye or alternate between both eyes, and may be noticed from birth or develop in early childhood, under the age of 5. A squint is not something a child will grow out of on their own, and early treatment is essential to prevent lasting effects on vision.
When the eyes are misaligned, the brain receives two different images. In children, the brain adapts by suppressing the image from the turned eye, which can cause amblyopia (lazy eye), a permanent reduction in vision in that eye. A squint also affects depth perception and binocular vision. Early treatment significantly improves outcomes.
Yes, many pre-school children with a squint can be treated successfully without surgery. Treatment may include glasses to correct an underlying refractive error (particularly long-sightedness), patching therapy for amblyopia, and exercises. Surgery is recommended when non-surgical measures are insufficient to align the eyes.
Treatment should begin as early as possible. The visual system is most malleable in the first seven years of life, the critical period during which amblyopia can be treated most effectively. After the age of seven or eight, the brain's plasticity reduces and treatment becomes less effective. Early intervention is strongly recommended.
Squint surgery is one of the most commonly performed paediatric eye operations and has an excellent safety record. It is carried out under general anaesthetic at a specialist day-case surgical unit, typically taking 30 to 60 minutes, and most children go home the same day. Your consultant will discuss the benefits, risks and what to expect in detail before any decision is made.
Assessment for a childhood squint at Clinica London involves both a paediatric ophthalmologist and one of our consultant orthoptists, often in the same appointment. Together, they build a complete picture of your child's eye alignment, vision and visual development before recommending a treatment plan.
Your child will be assessed by one of our consultant orthoptists, who will test vision in each eye separately, assess eye alignment using cover tests and prisms, measure the angle of the squint, and evaluate binocular vision and depth perception, using age-appropriate techniques for children of all ages, including pre-verbal toddlers.
The paediatric ophthalmologist will review the orthoptist's findings, take a full history and examine your child's eyes, including the back of the eye using dilating drops where needed. The consultant will assess whether a refractive error is contributing to the squint and confirm the most appropriate treatment.
Dilating drops are used to relax the focusing muscles of the eye, allowing the consultant to measure the true refractive error. This is essential in children: without drops, children can unconsciously compensate, giving a misleading result. The drops sting briefly and vision will be blurred for a few hours after the appointment.
Once all assessments are complete, the consultant will explain the findings clearly and discuss the recommended treatment plan, whether that is glasses, patching, surgery or a combination. There is no obligation, and all questions are welcome. A full written report will be sent to your GP.
If glasses are needed, a prescription will be given at the appointment. If patching is recommended, our orthoptists will guide you on how to introduce it with minimum distress. If surgery is advised, your consultant will explain the procedure, risks, benefits and what to expect on the day.
Squint management in children is an ongoing process. Regular follow-up appointments are essential to monitor vision development, adjust glasses prescriptions, review patching, and assess the response to treatment. Our team will agree a follow-up schedule and remain available between appointments.
Squint assessment and treatment at Clinica London is a team effort. Our paediatric ophthalmologists lead diagnosis and surgical planning, while our consultant orthoptists are central to ongoing monitoring and non-surgical management.
Founder and Medical Director of Clinica London. Specialist in adult strabismus and oculoplastic surgery, also seeing paediatric patients with eyelid and lacrimal conditions, and squint and amblyopia management in children, working closely with the orthoptists.
Our orthoptic team is at the heart of childhood squint care at Clinica London. Orthoptists specialise in the assessment and non-surgical management of eye movement disorders, amblyopia and binocular vision problems, working alongside the consultant at every stage of treatment.
Specialist in paediatric squint assessment and amblyopia management, including patching therapy, prism assessment and orthoptic exercises.
Experienced in orthoptic assessment of children of all ages, including complex squint cases and post-surgical follow-up care.
Specialist in childhood strabismus, binocular vision and amblyopia treatment, including assessment of complex and long-standing squints.
Early diagnosis and treatment gives the best chance of restoring normal visual development. No GP referral needed.
Book a children's squint assessmentAll fees are for private appointments at 140 Harley Street. A full fee breakdown will be provided at the time of booking. Squint surgery fees are provided separately by your consultant and the surgical unit.
| Appointment | Fee |
|---|---|
| New patient consultation, Consultant Ophthalmologist (not including more complex diagnostic tests) | £335–£400 |
| Orthoptic assessment (first appointment) and follow-up assessment | £150 |
| Combined consultant and orthoptist appointment | Fee on enquiry |
| Follow-up assessment by Consultant Ophthalmologist | £315–£350 |
| Squint surgery (paediatric day-case procedure) | Fee on consultation |
Squints are classified by the direction in which the eye turns and by whether the misalignment is constant or intermittent. Understanding the type of squint is essential to planning the right treatment. A squint can appear soon after birth, in an infant less than one year old, in a toddler or a pre-school child.
The most common type of squint in children. One eye turns inward toward the nose. This is often associated with long-sightedness (hypermetropia): when the eye over-focuses to compensate for the refractive error, it pulls inward. Glasses alone can sometimes fully correct an accommodative esotropia.
One eye turns outward, away from the nose. This may be intermittent at first, often noticed when a child is tired, daydreaming or looking into the distance, and may become constant over time. Exotropia may require patching, exercises or surgery depending on its size and frequency.
One eye sits higher (hypertropia) or lower (hypotropia) than the other. Vertical squints are less common but can cause significant problems with binocular vision and may require surgical correction. They may coexist with a horizontal squint.
Some children appear to have a squint due to a wide, flat nasal bridge that covers part of the white of the eye, giving a false impression of misalignment. This is called a pseudosquint and does not require treatment. An orthoptic assessment will confirm whether the eyes are truly aligned or genuinely misaligned.
A squint may be present all the time (constant) or only sometimes (intermittent). An intermittent squint can be easy to miss; you may notice it only when your child is tired, unwell or looking at a distant object. Both types warrant specialist assessment and should not be dismissed as "just tiredness."
The exact cause of a squint is not always clear, but several factors are known to play a role. In children, a squint is almost always related to problems with how the visual system develops, rather than a sign of a serious underlying illness.
Long-sightedness (hypermetropia) is the most common cause of childhood squint. When a child strains to focus, the eyes over-converge, causing one to turn inward. Correcting the refractive error with glasses may resolve the squint entirely.
The six muscles that control each eye must work in perfect coordination. If one muscle is stronger or weaker than its counterpart, the eye may be pulled out of alignment. This can occur from birth or develop in early childhood.
Squint runs in families. If a parent or sibling has had a squint, a child has a significantly higher chance of developing one. Any child with a family history of squint should be seen by a specialist, even if no obvious turn is present.
Babies born prematurely are at higher risk of squint and other visual problems. Premature babies should have scheduled eye checks, and any concern about alignment should be investigated promptly.
Conditions affecting the brain or nervous system, including cerebral palsy, hydrocephalus or Down's syndrome, are associated with a higher incidence of squint. A squint may also occasionally be the first sign of a problem with the optic nerve or retina.
A squint can sometimes develop or become apparent after a childhood illness with fever, a head injury, or following surgery involving general anaesthetic. A squint that appears suddenly always warrants prompt specialist assessment.
Treatment is tailored to your child's age, the type and size of squint, and whether amblyopia (lazy eye) is present. Most children require a combination of approaches, and treatment often takes place over months or years. The goal is always to achieve the straightest possible eyes and the best possible vision in both eyes.
Where a refractive error, particularly long-sightedness, is contributing to the squint, glasses are prescribed first. In some children (accommodative esotropia), glasses alone will fully correct the squint. A full cycloplegic refraction is essential to determine the correct prescription. Glasses may need to be worn full-time and updated regularly as the child grows.
If amblyopia (lazy eye) is present, which it often is when a squint has been present for some time, patching the stronger eye forces the brain to use and develop the weaker eye. Patching is most effective when started early, within the critical period of visual development. Our orthoptists monitor progress closely throughout.
For older children with intermittent or convergence-related squints, exercises prescribed and supervised by our orthoptists can strengthen binocular vision and improve eye control. Exercises are typically used alongside glasses or after surgery to consolidate results.
When the squint does not fully resolve with glasses and amblyopia treatment, surgery is recommended. It adjusts the tension of one or more of the muscles controlling eye movement, repositioning the eye. Performed under general anaesthetic at a specialist day-case unit, typically taking 30 to 60 minutes. Surgery does not replace glasses or patching; these usually continue afterwards to maintain results and treat any residual amblyopia. Some children need more than one procedure to refine alignment.
No GP referral needed. Speak to our team at 140 Harley Street.
Book a children's squint assessment
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