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Strabismus (ReelDx + Lecture)

VIDEO-CASE-PRESENTATION-REEL-DX

Strabismus

Patient will present as → a 3-year-old girl brought to you by her mother who is worried about her daughters "lazy eye." She reports that her daughters symptoms are exaggerated when she has a cold. Past medical history is negative for trauma or headaches. The patient has an asymmetric corneal light reflex and the cover/uncover test reveals a right sided esotropia. You refer the patient to a pediatric opthamologist.

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Strabismus is defined as any form of ocular misalignment. It derives from the Greek word strabismus (to squint)

  • Strabismus can be intermittent or constant
  • There are many types of strabismus, which are defined by the direction of misalignment

The cover/uncover test is used to diagnose strabismus

Treatment options can include glasses, occlusion therapy, orthoptic exercises, surgery, or a combination of these therapies.

  • Glasses are the primary treatment for a common form of strabismus—accommodative esotropia.
  • Occlusion therapy is typically used for amblyopia rather than strabismus. If occlusion therapy improves vision, occasionally, the strabismus may improve, but more importantly, better vision improves the prognosis for strabismus treatment.
  • Eye exercises (orthoptic exercises) are useful in patients with convergence insufficiency. There is no evidence that they improve typical childhood esotropia and exotropia.

strabismus

Question 1
Which of the following is diagnosed by use of the cover/uncover test?
A
Adie's pupil
Hint:
Adie's pupil is a sluggish pupil reaction to light and accommodation, evaluated by papillary reaction to light.
B
Strabismus
C
Glaucoma
Hint:
Tonometry is used to measure intraocular pressure to evaluate for glaucoma.
D
Myopia
Hint:
Myopia is evaluated by using a Snellen chart.
Question 1 Explanation: 
The cover/uncover test is used to diagnose strabismus.
Question 2
In infants, the eyes should move in parallel without deviation by the age of
A
2 weeks
Hint:
See C for explanation.
B
3 months
Hint:
See C for explanation.
C
6 months
D
1 year
Hint:
See C for explanation.
Question 2 Explanation: 
Intermittent alternating convergent strabismus is frequently noted for the first 6 months of life, but referral is indicated if it persists beyond 6 months.
Question 3
At what age should a child's eyes be consistently well-aligned?
A
Two months
Hint:
See B for explanation.
B
Six months
C
Twelve months
Hint:
See B for explanation.
D
Eighteen months
Hint:
See B for explanation.
Question 3 Explanation: 
A child's eyes should be consistently well-aligned by five to six months of age.
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