Do children grow out of a squint?

In the first weeks of life an eye position that is still unsteady is nothing unusual, because the way the two eyes work together is only just settling in. A squint that persists beyond that, or that keeps standing out, does not grow out — at most it becomes less visible while the brain begins to pass the deviating eye over. That is exactly the problem: the look of it improves, the visual development does not. So do not wait until a child seems 'old enough'. An examination that gives the all clear costs an appointment; one that comes too late costs acuity that can only be made up to a limited extent.

At what point is a squint in a baby or toddler something that stands out?

Anything that stands out to you does — parents see it earlier than any statistic. Have your child examined if one eye deviates inwards or outwards, even if it appears only at times or only when the child is tired; if the head is held permanently tilted or turned when looking at something; if one eye screws up more than the other in the sun; or if a child is noticeably unsteady on stairs and at ball games. A whitish or absent red reflex on a flash photograph is a case of its own: it must be assessed without delay and must not be watched — with a baby or toddler go directly to a children's eye clinic or an ophthalmic emergency department for that. We examine children from kindergarten age; with babies and toddlers, with a pronounced squint and with complex forms of weak sight we clarify by phone whether a consultation specialising in paediatric ophthalmology is the better place, and help you find the way there.

What is the difference between a squint and weak sight?

A squint describes the position of the eyes, weak sight (amblyopia) the acuity. A child can squint without being weak-sighted, and can be weak-sighted without ever squinting — for instance when one eye has a markedly stronger refractive error than the other and therefore delivers a blurrier image while both eyes stand straight. The two are nevertheless closely connected: an eye that deviates permanently delivers the brain a second, disturbing image, and the brain suppresses it. If that suppression is not interrupted in time, the eye stays weak-sighted although — once an organic cause has been ruled out — it is soundly built. The connection holds in the other direction as well: an eye that delivers no usable image because of a disease starts squinting for that reason. That is why with every suspected squint the acuity of each eye is tested separately and the inside of the eye is assessed in addition — and not only the position measured.

Can a squint be trained away with eye exercises?

With a latent squint that decompensates only on tiring, targeted orthoptic exercises can ease the symptoms — that is the one area in which training really does achieve something, and it is guided at an orthoptic consultation after an examination, not by a video. We assess whether that comes into question in your case and arrange the referral; the exercises themselves are not guided by us. A manifest squint is not straightened by them in any case, and weak sight cannot be 'exercised away': what helps there is the right pair of glasses and consistent use of the weaker eye. Vision-training programmes, food supplements or deliberately leaving the glasses off change nothing about the position of the eyes. We tell you openly when we think nothing of something — and just as openly when exercises make sense in your case.

What happens at an orthoptic examination ('vision school') — and does it take place with you?

It is the actual measurement of eye position and takes longer than an ordinary check, because it answers several questions one after another. What is tested is the acuity of each eye separately, the position in the cover test — one eye is covered in turn and the corrective movement of the other observed —, the range of movement of both eyes in every direction of gaze, how they work together for near vision, and spatial vision. In children, determining the spectacle values under pupil-dilating drops is added, because a child's power of focusing otherwise hides long-sightedness. We do not have an orthoptic consultation of our own: what takes place with us is the ophthalmic initial assessment — acuity, cover test, range of movement and the spectacle values under drops — and where the full orthoptic examination is needed, we register you at a specialised consultation. None of it hurts; what is tiring is above all the co-operation it asks for. Allow time, and bring a pair of sunglasses for the journey home.

When does squint surgery become necessary — and what does it achieve?

Surgery comes into question when glasses, treatment of weak sight and, where useful, prisms do not influence the angle of the squint enough and the deviation is a problem: because it causes double vision, because a forced posture of the head is needed to avoid it, or because binocular vision cannot otherwise be developed or restored. The procedure changes the insertion or the length of individual external eye muscles and so corrects the position — it does not create acuity that was not laid down in childhood, and it does not replace glasses that are still needed. Sometimes more than one procedure is necessary, and the risks belong with that: the angle can remain over- or under-corrected, and in adults double vision can appear afresh afterwards or persist. That belongs said beforehand and not afterwards. We assess, judge whether a procedure comes into question at all, and discuss that with you; the surgical indication is set by the centre that carries out the procedure, and we organise the referral there.

Squint

Squint (strabismus) — when both eyes do not meet the same target

'In the holiday photos one eye is looking off somewhere.' That is how most conversations about squint begin — strabismus, in medical terms. Behind it there is rarely a problem of appearance and almost always a question about binocular vision: only when both eyes meet the same target can the brain make one image with depth out of two. If one eye deviates, that depth is missing — and in childhood the brain can pass the deviating eye over permanently.

book an appointment online Call us — a sudden squint today

What a squint is — and why it is not a question of looks

A squint means that the two eyes are not directed at the same target at the same time: one fixates, the other deviates — inwards, outwards, more rarely upwards or downwards. Six external eye muscles move each eyeball, and the brain controls all twelve so that both eyes work as a pair. If one eye deviates, either that control is disturbed, or a muscle or its nerve is damaged — or the eye delivers an image so blurred that the two never come to work together in the first place.

The decisive point is what gets lost in the process. Two straight eyes deliver two minimally different images, and out of that difference the brain builds spatial vision: distances, depth, reaching for a glass with confidence, the step onto a stair. That achievement is called binocular vision, and it is the real reason why a squint needs assessing. The appearance is the consequence that gets noticed; spatial vision is the function that is at stake.

A squint is therefore also not a matter of Refractive errors. A refractive error describes how strongly a single eye bends the light; a squint describes where the two eyes are pointing. The two nevertheless meet regularly, because an uncorrected refractive error is one of the commonest causes of a squint in childhood — more on that further down.

What that feels like depends on age, and the difference is large. A child sees no double vision: the child's brain is still malleable enough simply to suppress the disturbing second image. That is convenient and dangerous at once — the symptoms stay away, the visual development of the deviating eye does not. An adult can no longer build up that suppression. In an adult a newly appearing squint announces itself immediately with double vision, and that is exactly why in an adult it is a warning sign and not a blemish. One exception belongs with that: anyone who squinted as a child, or who sees badly with one eye, may notice a new deviation without double vision — even then it counts as new and is assessed straight away.

Amblyopia: why early treatment is decisive in children

Sight is not a finished ability at birth but something the brain learns in the first years of life. It learns it from what arrives. If an eye gets no sharp or no usable image over a longer period, the processing of that eye is not built up — the eye stays weak-sighted although, once an organic cause has been ruled out, it is soundly built. That is amblyopia, called weak sight in everyday speech.

With a squint it arises by a detour: the deviating eye delivers an image from another direction that does not match the first. To escape double vision, the child's brain suppresses this second image permanently. So it does not stop at a crooked position — the eye that is passed over loses visual performance, often without anyone noticing, because the dominant eye takes everything over.

The connection runs the other way as well, and that direction is the more important one: A squint can be the consequence of an eye disease. If an eye delivers no usable image — through a one-sided clouding of the lens, a disease of the optic nerve or, rarely, a tumour of the retina —, then it deviates, because it lacks the reason to stand straight. That is why assessing a squint in a child always includes examining the back of the eye with the pupil dilated and testing the red reflex, and not only measuring the position. A whitish or absent red reflex on a flash photograph is not watched but assessed without delay — with a baby or toddler directly at a children's eye clinic or an ophthalmic emergency department.

Two things make this treacherous. First, nobody reports it: children have nothing to compare with and take their own vision to be normal, and with both eyes open their sight is entirely unremarkable. Second, the window of time is limited. What was not laid down in the formative years can only be partly made up later — the younger the child at the start of treatment, the better the prospects. That is not an incantation but the reason why in children an examination with no particular prompt genuinely does change something.

Amblyopia is not found by appearance but by the number: it is only when the acuity of each eye is tested separately that the difference between the two sides shows. A child who 'sees well' sees well with the better eye — that says nothing about the other. So we test acuity one side at a time and cover consistently for it, even when the child protests; the protest itself, incidentally, is already a finding when it comes only on one side.

Double vision with a disturbance of language, weakness or a severe headache? This combination is not an eye problem but an emergency of the whole person: call the ambulance (144) immediately. The same applies to a newly drooping upper lid with double vision and a wide pupil on the same side — straight to an emergency department, do not wait for an appointment.

An adult suddenly squinting, a child newly squinting? Both need assessing the same day: +41 44 500 69 00. Outside consultation hours, the ophthalmic emergency service applies.

A word on safety

We also tell you when there is nothing to be done. An apparent squint in a baby is not treated but explained, and a latent squint without symptoms needs no prisms merely because it can be measured. And when your child's treatment belongs at a place with its own squint clinic, we say so at the first appointment and not at the third.

The forms of squint

'Squint' is an umbrella term, and the forms behind it call for entirely different treatments. They differ in the direction of the deviation, in whether it is visible all the time, and above all in whether a control system has gone out of balance or a nerve or muscle has failed.

Convergent squint (esotropia)

One eye turns inwards, towards the nose. It is the commonest form in childhood and parents usually notice it first when the child is looking at things close up or is tired. An important subgroup is accommodative convergent squint: focusing and turning the eyes inwards are coupled together in the brain, and a long-sighted child has to focus hard even for ordinary seeing — and takes the inward turn along with it without meaning to. The remarkable part of it: a correctly prescribed pair of glasses takes exactly that effort off the child, and the position of the eyes often returns to normal, wholly or in part. Why long-sightedness in children can trigger a convergent squint, and why the glasses are then treatment and not comfort, is set out in detail on the page about it.

Divergent squint (exotropia)

One eye deviates outwards, towards the temple. This form often begins intermittently: it shows itself when looking into the distance, when daydreaming, when tired or in bright light, while the eyes stand straight for reading. It is exactly this inconstancy that leaves families wavering for a long time over whether they saw anything at all. A long-standing, intermittent divergent squint is no reason to hurry on the same day, but a good reason for an appointment — what is assessed is how often and how long the deviation appears and whether spatial vision is preserved with it. Newly appeared, it is something else and, like any newly appeared squint in a child, needs assessing straight away: an intermittent outward squint too can be the first visible consequence of an eye disease, as described in the section above.

Latent squint (heterophoria)

A latent squint is the tendency of the eyes to deviate from each other, which in daily life is compensated for by the two eyes working together. It is extremely common and in the vast majority of cases entirely without pathological significance. It only becomes noticeable when the compensating costs effort and the effort runs out: after long spells at a screen, when overtired, in the recovery phase after an illness. Typical symptoms are headaches towards evening, burning eyes, blurring or brief double vision while reading, and the impression of losing your place on the line. A latent squint without symptoms is not treated merely because it can be measured — that is one of the sentences that ought to stand expressly on this page. One pattern, though, expressly does not belong here: double vision that has newly appeared and increases as the day goes on is something other than a decompensating latent squint — see the section on double vision further down.

Paralytic squint (paretic squint)

Here it is not the balance of the control system that has shifted; an eye muscle, or the nerve that supplies it, is impaired in its function. What is characteristic is that the angle of the squint depends on the direction of gaze: in one direction the eyes stand almost straight, in the opposite direction they deviate markedly, and there the double vision is at its most disturbing. Many people affected hold the head turned or tilted without meaning to, because in that position the images fall together — a tilted head position is therefore a finding to be taken seriously and not a habit. A paralytic squint usually appears suddenly, has a cause outside the position of the eyes itself and needs assessing quickly: the next section is about exactly this situation.

Apparent squint (pseudostrabismus)

Not every child who squints really squints. In babies and toddlers the bridge of the nose is broad and the lid fold at the inner corner of the eye is pronounced; that makes less of the white of the eye visible on the nasal side, and the eyes look turned inwards even though they are straight. This apparent squint is harmless and grows out with the face. It cannot, however, be told apart on a photograph or by family consensus, only at the examination — which is why the advice is not 'wait and see' but 'have it looked at once and then stop worrying'.

A sudden squint in an adult is a warning sign

A squint that is new in an adult is something fundamentally different from a squint that has been there since childhood. The mature brain can no longer suppress the second image — which is why the double vision comes straight away, and why the complaint is so unambiguous. The cause almost never lies in the position of the eyes itself, but in whatever is impairing a muscle, a nerve or the control of them: a circulatory problem, an inflammation — including one of the temporal arteries —, a disease of the thyroid, pressure from outside on a nerve, a disturbed transmission of signals from nerve to muscle, more rarely something else. Which of them is present is decided not by the angle of the squint but by the examination and, where necessary, by imaging that we arrange.

Because the urgency is not the same in every case, we separate them here as clearly as we can:

Immediately — call the ambulance (144), not the ophthalmologist first: double vision together with a disturbance of language, speech or swallowing, weakness or altered sensation in one half of the body, a drooping corner of the mouth, spinning vertigo, or a sudden, severe headache of a kind you have not had before. These signs point to an event in the brain, and there minutes count.

Straight to an emergency department: a newly drooping upper lid together with double vision and a wide pupil on the same side. This combination has a small number of possible causes, at least one of which tolerates no delay — it needs assessing that same night and not the next morning.

Equally immediate, and not 'later today': newly appeared double vision in an adult from middle age onwards together with a new kind of pain in the head or the temples, pain on chewing, a scalp tender to pressure, exhaustion or brief blackouts of vision. An inflammation of the temporal arteries can be behind it. It is treated immediately, because otherwise permanent blindness threatens within days — and in both eyes.

To be assessed the same day: newly appeared double vision or a newly deviating eye without the accompanying signs named above; likewise double vision that appears after a fall or a blow to the head or the eye socket. Call us about that: +41 44 500 69 00, Mon–Fri 08:00–12:00 / 13:00–17:30. Outside these hours the ophthalmic emergency service applies.

Soon, but not as an emergency: a squint of many years' standing that has become larger; a compensatory head posture that is increasing; an outward squint that appears more and more often. Here it is the course that matters, and that is better judged at a planned appointment than on the doorstep.

A word about the wheel: With freshly appeared double vision you do not drive yourself. That is not a precaution but a question of fitness to drive — and it is one of the points we raise in conversation, together with the question of on what conditions, and from when, it is possible again.

Assessing eye position: what we measure — and what orthoptics measures

The examination of eye position is called orthoptics; in everyday speech the name vision school has taken hold for it, which is a little misleading — exercises are rarely done there, measuring almost always. It answers four questions one after another, and none of them can be skipped: how well does each eye see on its own? How do the eyes stand in relation to each other? How freely do they move in every direction? And do they work together? We do not run an orthoptic consultation of our own. What takes place with us is the ophthalmic initial assessment — the acuity of each eye separately, the cover test, the range of movement and, in children, the spectacle values under drops. Where a full orthoptic work-up is needed beyond that, we say so and arrange the referral to a specialised orthoptic or strabismus consultation.

Visual acuity of each eye separately

The beginning and the most important part, particularly in children. Testing is done one side at a time, with pictures or symbols if a child is not yet reading. A clear difference between the eyes is the finding that matters — it separates a squint with healthy visual development from one where weak sight is beginning, and it decides the whole of the treatment that follows.

Cover test and measuring the angle of the squint

In the cover test one eye is covered in turn and it is observed whether the other makes a corrective movement. It sounds plain, and it is the test on which the classification is decided: it distinguishes a manifest squint from a latent one and shows the direction of the deviation. With prisms held in front, the angle can then be put in numbers — at distance, at near and in different directions of gaze, because an angle that changes with the direction of gaze points to a paralytic squint.

Range of movement and double vision

Both eyes follow a target in every direction of gaze while it is assessed where a movement lags behind. Adults with double vision additionally describe in which direction of gaze the images stand furthest apart and whether they appear side by side, one above the other or tilted. These accounts are not a side note — they show which muscle, and so which nerve, is affected.

Binocular and spatial vision

What is tested is whether the brain fuses the two images into one at all, and how finely it resolves depth in doing so. The result changes the advice considerably: spatial vision that is still present is something you want to preserve; spatial vision that was never laid down cannot be produced after the fact by any measure — and anyone who knows that beforehand has different expectations of a treatment.

Spectacle values under drops — the rule in children

In children the power of focusing is so great that the ordinary measurement underestimates long-sightedness or hides it altogether. That is why, where this is the question, we determine the spectacle values under drops that dilate the pupil and relax focusing at near. In practice that means wide pupils, blurred near vision and sensitivity to glare for a few hours, in children often until the next day. Bring a pair of sunglasses or a cap with a peak, and plan the rest of the day without homework. How an examination appointment with us otherwise runs, what to bring and how long it takes, is set out under Eye examinations: what happens, the procedures and how to prepare.

A practical note, because it saves waiting: say when you book what it is about — whether a child has newly started squinting, whether an adult is seeing double, whether it is a follow-up. We then allow enough time for the ophthalmic assessment and tell you beforehand whether drops will be used. If that assessment shows that a full orthoptic examination is needed, we register you at a specialised consultation — you do not have to arrange it yourself.

Treatment: glasses, occlusion, prisms, surgery

The treatment follows the finding, not the look of it. In children it has two aims, which are not the same thing: to develop the acuity of the weaker eye and, where possible, to establish how the two eyes work together. The straight position is a means in that, and sometimes a result — it is never the sole purpose. In adults a third aim comes on top, and day to day it is often the most important: getting rid of the double vision.

Glasses — more often the treatment than the visual aid

It almost always begins with full correction of the refractive error. With an accommodative convergent squint the glasses are not an accessory but the treatment itself: they take off the child the focusing work on which the inward turn depends, and the position of the eyes often returns to normal, wholly or in part. That also explains why wearing them consistently is not a question of upbringing here but a medical one — and why a deliberately under-strength pair of glasses 'for training' does nobody any good.

Occlusion — patching the better eye

If weak sight is present, glasses are not enough: the brain has to be forced to use the eye it has been passing over. For that the better eye is patched for periods — for many families the most surprising part of the treatment, because the instinct is to protect the worse eye. How much and for how long depends on age and on the difference in acuity, and is adjusted as things develop; checks are regular, because the patched eye too must not lose ground under the treatment. Honesty belongs here: the hardest side of this treatment is not the medical one. A child whose good eye is taped over sees worse during that time — and notices it. So we talk through daily life with you, not only the plan. And if the patch does not hold up day to day — because the skin will not take it, or because the child pulls it off as soon as nobody is looking —, that is not a failure of the treatment: there is a second route, in which the better eye is blurred for near vision with drops and so put in the background in the same way. Which suits your case better we decide with you and not by a formula.

Prisms — moving the images together instead of moving muscles

Prisms deflect the light so that the two images meet each other again, without anything changing at the eye itself. They come into question above all with smaller angles of squint and with double vision that is to be bridged over — as a stick-on film for as long as the angle is still changing, as a prism ground into the lens once it is stable. They are not a treatment of the cause and they straighten no eye; they make seeing usable. Whether a prism correction comes into question for you follows from the measured eye position and not from the severity of the symptoms; the orthoptic measurement needed for it is one we arrange at a specialised consultation.

Surgery — when it comes into question

Squint surgery changes the insertion or the length of individual external eye muscles, and with that the position of the eye. It comes up for discussion when glasses, treatment of weak sight and, where useful, prisms do not influence the angle of the squint enough and the deviation is a problem: through double vision, through a forced posture of the head, or because binocular vision cannot be developed or restored any other way. What it achieves and what it does not belongs said beforehand: it corrects the position. It does not create acuity that was not laid down in childhood, it does not do away with glasses that are still needed, and sometimes more than one procedure is necessary. The risks belong with these limits too, and we say them beforehand: the angle can remain over- or under-corrected, and in an adult double vision can appear afresh after the procedure or persist. Anyone who has talked about it beforehand does not experience it afterwards as a setback.

How we go about it we are glad to say beforehand: we assess, judge whether a procedure comes into question at all, and discuss that with you. The surgical indication is set by the centre that carries out the procedure; we organise the referral to a centre with its own squint clinic, without your having to see to it yourself. Whether the pre-operative examination and the follow-up checks can take place close to where you live with us in Zürich, Wetzikon or Meilen, we clarify with you and with the clinic performing the operation — and we tell you before you decide. Referring colleagues will find the details for registration under Referring physicians.

And the practical part: if something has stood out to you about your child or about yourself, the next step is not a big one. Describe to us on the phone what you have observed and since when, or book the appointment for the assessment online. With a newly appeared squint and with fresh double vision please call rather than book online. We tell you on the phone how quickly we can see you: during consultation hours as a rule the same day; outside them we tell you where to go. +41 44 500 69 00.

Double vision in adults

Double vision is the complaint adults most often come with on the subject of squint — and it is not all the same. The first distinction you can make yourself, before you even pick up the phone: cover one eye. If the double vision disappears as soon as one eye is covered, it comes from the way the two eyes work together — we then assess that ophthalmically and, where needed, arrange the orthoptic examination at a specialised consultation. If it persists although only one eye is open, the cause lies in that eye itself; behind that there is often something in the cornea or the lens, such as an advanced clouding of the lens, and the treatment is an entirely different one.

The second question is the one about the course over time. Freshly appeared double vision needs assessing the same day — with the exceptions above, which belong straight in an emergency department. Double vision that increases slowly over weeks points to something other than double vision that was there from one day to the next, and double vision that appears only in the evening or only when tired is a third situation again. It fits a latent squint that is decompensating — but the same pattern has a second, more serious culprit: if the transmission of signals from nerve to muscle is disturbed, double vision increases as the day goes on, improves after a rest and often goes with an upper lid that droops towards evening. Newly appeared double vision that fluctuates through the day we therefore do not read as 'just tired' but assess — including when it has disappeared again the next morning. If difficulty swallowing, speaking or breathing joins it, that is an emergency and not an eye matter: call the ambulance (144).

What helps then is guided by the cause and not by the complaint. Some of these palsies resolve on their own over weeks to months; during that time it is about making daily life bearable — with a stick-on prism film that can be adjusted for as long as the angle is still changing, or, if that does not hold up, with temporarily covering one eye, which switches the double vision off. Only once the finding has stayed stable over months is a lasting solution decided on: prisms ground into the lens, or a procedure on the eye muscles. This order is not stalling but the reason why in the end one does not correct twice.

Two things we say of our own accord, because they otherwise get lost in conversation. First, every new disturbance of the eye muscles brings with it the question of the cause outside the eye — blood pressure, diabetes, the thyroid, and depending on the constellation imaging or a joint assessment by neurology, which we arrange and do not leave to you. Second, fitness to drive: as long as you are seeing double, you do not drive. We tell you what changes that, and when.

Costs & health insurance

What basic health insurance covers — and what it does not

For the cost question what counts is the reason, not the device. Assessing a squint is treatment of illness in children as in adults — including when the answer at the end is all clear. With the aid that follows it becomes more differentiated, and that is exactly where the misunderstandings arise.

Service	Coverage	What this means for you
Ophthalmic assessment for a squint or suspected squint	Basic insurance (OKP)	A deviating eye, a tilted head position, new double vision or an eye test that stands out are a medical question. Your deductible and co-payment apply as at any doctor's appointment; children have no deductible in the standard model (unless an optional deductible has been chosen), and the co-payment applies.
Orthoptic examination at a specialised consultation	Basic health insurance where indicated	This examination does not take place with us. We carry out the ophthalmic initial assessment, issue the referral and take on the follow-up checks that a treatment once begun requires; where there is a finding or a well-founded suspicion, both are part of treatment of illness and not to be negotiated separately.
Determining the spectacle values under drops in children	Basic insurance (OKP)	Where this is the question, cycloplegic refraction is not an additional service but as a rule the only measurement that delivers a reliable value in a child.
Spectacle lenses and frame	Limited contribution	For children there is a statutory arrangement with a limited annual contribution, and beyond that with certain eye conditions. In adults, basic health insurance does not as a rule cover the visual aid; some supplementary insurance policies contribute.
Occlusion treatment for weak sight	Subject to conditions	The medical checks during the treatment are treatment of illness. Whether the material itself is reimbursed, and to what extent, depends on the insurer and on the finding — we settle that before starting, so that you do not learn of it from the invoice.
Prism film or prisms ground into the lens for double vision	Subject to conditions	Prescribing them requires a documented indication; reimbursement follows the rules for visual aids and is limited in adults. What applies in your case we tell you before the fitting — in writing if there is any doubt, see Contact.
Squint surgery where medically indicated	Basic health insurance where indicated	Double vision, a compensatory head posture or binocular vision that cannot be achieved any other way are grounds for the indication. We assess and discuss with you whether a procedure comes into question; the surgical indication is set by the centre that carries it out. We organise the referral, and it costs you nothing extra.
A procedure purely because of appearance, without a medical indication	Self-pay service	A procedure without a functional justification is not a mandatory benefit and is paid for by you. We tell you beforehand which category your concern falls into — and we say it even when the answer is uncomfortable.

Deductible and co-payment. Of the costs that run through basic health insurance, you first bear your chosen deductible in full, then the co-payment up to the statutory maximum per year. Children have no deductible in the standard model — unless an optional deductible has been chosen —, and the co-payment applies to them too. Treatment 'at the insurer's expense' is therefore rarely free of charge — that is not a peculiarity of our clinic but the way Swiss basic health insurance is built.

Unsure which category your concern falls into? Say so when you book, and we will tell you before the appointment and not after it: +41 44 500 69 00, Mon–Fri 08:00–12:00 / 13:00–17:30. An overview of our other consultations is under Ophthalmology.

Related conditions

Hyperopia (long-sightedness)Eye examinations Refractive errors

Medically reviewed by Dr. med. Annette Schumann

Your ophthalmologistDr. med. Annette SchumannView profile

Frequently asked questions

: In the first weeks of life an eye position that is still unsteady is nothing unusual, because the way the two eyes work together is only just settling in. A squint that persists beyond that, or that keeps standing out, does not grow out — at most it becomes less visible while the brain begins to pass the deviating eye over. That is exactly the problem: the look of it improves, the visual development does not. So do not wait until a child seems 'old enough'. An examination that gives the all clear costs an appointment; one that comes too late costs acuity that can only be made up to a limited extent.
: Anything that stands out to you does — parents see it earlier than any statistic. Have your child examined if one eye deviates inwards or outwards, even if it appears only at times or only when the child is tired; if the head is held permanently tilted or turned when looking at something; if one eye screws up more than the other in the sun; or if a child is noticeably unsteady on stairs and at ball games. A whitish or absent red reflex on a flash photograph is a case of its own: it must be assessed without delay and must not be watched — with a baby or toddler go directly to a children's eye clinic or an ophthalmic emergency department for that. We examine children from kindergarten age; with babies and toddlers, with a pronounced squint and with complex forms of weak sight we clarify by phone whether a consultation specialising in paediatric ophthalmology is the better place, and help you find the way there.
: A squint describes the position of the eyes, weak sight (amblyopia) the acuity. A child can squint without being weak-sighted, and can be weak-sighted without ever squinting — for instance when one eye has a markedly stronger refractive error than the other and therefore delivers a blurrier image while both eyes stand straight. The two are nevertheless closely connected: an eye that deviates permanently delivers the brain a second, disturbing image, and the brain suppresses it. If that suppression is not interrupted in time, the eye stays weak-sighted although — once an organic cause has been ruled out — it is soundly built. The connection holds in the other direction as well: an eye that delivers no usable image because of a disease starts squinting for that reason. That is why with every suspected squint the acuity of each eye is tested separately and the inside of the eye is assessed in addition — and not only the position measured.
: With a latent squint that decompensates only on tiring, targeted orthoptic exercises can ease the symptoms — that is the one area in which training really does achieve something, and it is guided at an orthoptic consultation after an examination, not by a video. We assess whether that comes into question in your case and arrange the referral; the exercises themselves are not guided by us. A manifest squint is not straightened by them in any case, and weak sight cannot be 'exercised away': what helps there is the right pair of glasses and consistent use of the weaker eye. Vision-training programmes, food supplements or deliberately leaving the glasses off change nothing about the position of the eyes. We tell you openly when we think nothing of something — and just as openly when exercises make sense in your case.
: Newly appeared double vision in an adult is never a cosmetic matter and needs assessing the same day. Call us; outside consultation hours the ophthalmic emergency service applies. There are two constellations in which you do not wait for an appointment: if a disturbance of language, speech or swallowing, weakness or altered sensation in one half of the body, a drooping corner of the mouth, spinning vertigo or a sudden severe headache joins the double vision, call the ambulance (144) at once — that is an emergency of the whole person and not of the eye. And a newly drooping upper lid together with double vision and a wide pupil on the same side likewise needs examining immediately and not 'later today'. Do not drive yourself with fresh double vision.
: It is the actual measurement of eye position and takes longer than an ordinary check, because it answers several questions one after another. What is tested is the acuity of each eye separately, the position in the cover test — one eye is covered in turn and the corrective movement of the other observed —, the range of movement of both eyes in every direction of gaze, how they work together for near vision, and spatial vision. In children, determining the spectacle values under pupil-dilating drops is added, because a child's power of focusing otherwise hides long-sightedness. We do not have an orthoptic consultation of our own: what takes place with us is the ophthalmic initial assessment — acuity, cover test, range of movement and the spectacle values under drops — and where the full orthoptic examination is needed, we register you at a specialised consultation. None of it hurts; what is tiring is above all the co-operation it asks for. Allow time, and bring a pair of sunglasses for the journey home.
: Surgery comes into question when glasses, treatment of weak sight and, where useful, prisms do not influence the angle of the squint enough and the deviation is a problem: because it causes double vision, because a forced posture of the head is needed to avoid it, or because binocular vision cannot otherwise be developed or restored. The procedure changes the insertion or the length of individual external eye muscles and so corrects the position — it does not create acuity that was not laid down in childhood, and it does not replace glasses that are still needed. Sometimes more than one procedure is necessary, and the risks belong with that: the angle can remain over- or under-corrected, and in adults double vision can appear afresh afterwards or persist. That belongs said beforehand and not afterwards. We assess, judge whether a procedure comes into question at all, and discuss that with you; the surgical indication is set by the centre that carries out the procedure, and we organise the referral there.
: The ophthalmic assessment of a squint is treatment of illness, and so is the orthoptic examination at a specialised consultation; where there is a medical indication the cost is covered by basic health insurance. That holds for children as for adults, and expressly also when the answer at the end is all clear. Your deductible and co-payment apply as at any doctor's appointment; children have no deductible in the standard model (unless an optional deductible has been chosen), and the co-payment applies. It becomes more differentiated with the aids: for spectacle lenses in children there is a statutory arrangement with a limited annual contribution, and beyond that with certain eye conditions; in adults you bear the cost of the visual aid yourself as a rule. A procedure without a medical indication, purely because of appearance, is not a mandatory benefit. What applies in your case we settle with you before the treatment.

An eye that deviates ought to be looked at properly, once.

Tell us on the phone what you have noticed and since when — with a child, also whether it is there all the time or only at times. We then schedule the right amount of examination time and tell you beforehand whether drops will be used.

book an appointment online

+41 44 500 69 00 — Mon–Fri 08:00–12:00 / 13:00–17:30. Or in writing through the contact form.