When an adult presents with squint it is not only imperative to establish the type and amount of squint but also to establish and treat the cause of squint.

There are two main types: non-paralytic or paralytic squint (palsy). The non-paralytic variety either persisted from childhood or is a local eye muscle imbalance.

Any adult presenting with sudden onset of paralytic (palsy) squint has to be investigated in detail for the cause, which could be medical, e.g. hypertension, diabetes mellitus or surgical e.g. brain lesion. Majority of palsies correct on their own within 6 months.

Squints are slightly differently managed in adults because of the presence of double vision in the paralytic variety. Initially, to reduce the problems with double vision, prisms are incorporated into glasses. The strength of the prism may need to be adjusted as the degree of squint reduces.

Occasionally, the squint can be controlled with a Bot-Tox injection into one of the unaffected eye muscle to weaken it or surgery to strengthen the weak muscle.