Reviewed on : 7 Feb 2024

Reviewed by : Ashif Dhanani

Expires : 7 Feb 2026

Interim Referral Advice from February until 1 April 2024

Ophthalmology referrals will not be triaged or processed by the Referral Support Service during February and March

Referrals should be made DIRECTLY to the provider during this period

Referral queries should be directed to Advice & Guidance

History of Squint

If an adult patient attends your practice ‘noticing’ a squint, please do the following.

• Check Personal Ocular History – check if this is a new or old occurrence.

If the evidence points to a recent onset:

• If new please check and assess the relevant cranial nerves and ensure that no neurological insult has occurred, paying particular attention to whether there is any recent history of trauma and/or diplopia
• Due to delays in first appointments please consider if you wish to investigate patients for new-onset nerve palsies or send them to the eye casualty. Diabetes, smoking and hypertension are the most common causes of sudden onset VIth Nerve palsy in the >60years population.
• If the ‘new’ squint does not seem urgent ask the patient to have a sight test as the Optometrist can assess it.
• Consider using the community-based NHS Eye Care Service for assessment.
• If it is a squint it may be corrected refractively, but this is highly unlikely to correct a large squint in an adult.
• The Optometrist will refer back to you if it cannot be managed this way and if they do this send into RSS with the Optometrist referral

If there is evidence of previous history of squints etc please consider the following:

• If the eye turns in (Esotropia) and the patient does not wear spectacles again ask the patient to have a sight test if not done so as this may be corrected refractively.
• If it cannot be corrected refractively the Optometrist will refer the patient back to you.
• If the eye turns out (Exotropia) unless that eye has become more myopic it is difficult to treat refractively but again a sight test can glean useful information prior to a hospital referral.

Small squints may be managed refractively by the local Optometrists. When this is not possible the patient will need referral.

The mainstay of treatment at the hospital to diagnose and treat underlying pathology where present, and treat squints either with surgery or a prism. Patients should be aware that surgery may be an option.