Strabismus: The Daily PANCE Blueprint

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Strabismus: The Daily PANCE Blueprint

A 4-year-old boy is brought to the pediatrician by his parents, who have noticed that his right eye often "drifts" outward, especially when he is tired. This has been more noticeable over the past six months. On examination, when covering the left eye, the right eye moves inward to fixate on an object. When the right eye is covered, there is no movement of the left eye to maintain fixation. Which of the following is the most likely type of strabismus in this patient?

A. Esotropia
B. Exotropia
C. Hypertropia
D. Esophoria
E. Exophoria

Answer and topic summary

The answer is B. Exotropia

Exotropia is characterized by the outward deviation of an eye relative to the other when focusing on an object. It is often more noticeable when the patient is tired or not focusing on a near object, as described in the vignette. The cover test, where one eye moves to re-establish fixation when the other eye is covered, confirms the presence of a true strabismus (tropia) rather than a tendency or phoria, which is only apparent during the cover test and not during normal binocular vision.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint EENT ⇒ Vision abnormalities ⇒ Strabismus

Also covered as part of the Pediatric EOR topic lists