Ocular Motility

 

Introduction

A squint (strabismus) is a misalignment of the visual axis. While one eye is directed at an object, the other eye may turn in (esotropia), out (exotropia), up (hypertropia), or down (hypotropia)¹. This misalignment may be persistent or intermittent.

 

In Scope:

• Incomitant squint (there is a change in the angle of deviation in different positions of gaze)
   
• Concomitant squint with double vision (the deviation of the eyes remains constant with changes in the angle of gaze)

 

Not in Scope:

• Longstanding squint in those over 18yrs which has been present since childhood

 

Red Flags

• ataxia
   
• vomiting
   
• double vision
   
• nystagmus
   
• limited abduction
   
• headache
   
• abnormal neurological assessment/examination

This list is not exhaustive

 

Primary care assessment and management prior to referral

Further information on assessing a squint can be found here.

 

Advice and Guidance

Please send advice and guidance requests to Ophthalmology via eRS

 

Referral Instructions

Red flags

If any red flag features and patient over 18yrs discuss with acute GP/consider acute medical admission

If under 18yrs discuss with Paediatric on call team

 

Emergency Eye Casualty Referral

• Acute Incomitant Squint in the absence of red flags
   
• Consider checking CRP for Giant Cell Arteritis and review atherosclerotic risk factors, but do not delay referral

 

Routine Referrals to Orthoptist Clinic via eRS

• Chronic incomitant squint
   
• Concomitant squint with double vision
   
• Longstanding squint in a patient under 18 yrs of age causing embarrassment Service not commissioned for those over 18yrs with longstanding squint

 

Useful Resources

Professionals:

• Assessment | Diagnosis | Squint in children | CKS | NICE
• Scenario: Management | Management | Squint in children | CKS | NICE

 

Patients:

• Squint Clinic - What is a Squint? Strabismus, Squint Treatment, Lazy Eye Information, Type of Squint, Squint Operation / Surgery, Divergent Squint, Convergent Squint, Botox treatment, Squint guide, Squint help, Squint Videos.
• Strabismus and amblyopia in children | RNIB

 

References

• Squint in children | Health topics A to Z | CKS | NICE

 

Page Review Information

Date reviewed         27 October 2025

Next review due      27 October 2027

Sifter name             Dr Kate Northridge

Contributor              Dr David Jones, Consultant Ophthalmologist Royal Cornwall Hospital

                                Faye Gibson, Head Orthoptist Royal Cornwall Hospital