`The importance of
STRABISMUS in children
The Reasons:
1. Strabismus causes serious problems:
In children
vision is lost as a result of Strabismus- Amblyopia
Time: The first years of life are
critical. The failure to stimulate the visual brain in this period has a very
severe effect on visual development making it ALMOST IMPOSSIBLE TO DEVELOP
VISION LATER.
Amblyopia -
factors which can be involved:
1
Poor focus - the
need for corrective lens.
2
An opacity in the
line of vision
3
Poor aim – a
turned eye
2. Serious problems cause strabismus
Loss of
vision in an eye in infancy and childhood will result in Strabismus. Possible
Causes:
Retinoblastoma
Congenital cataract
Optic atrophy- (Cerebral tumours; Hydrocephalus)
Retinal scarring- Toxoplasmosis
When a child presents with
Strabismus:
1.
An
examination is indicated as soon as possible to exclude an organic cause.
2.
An
examination is indicated as soon as possible to exclude significant refractive
error.
3.
An
examination is indicated as soon as possible to commence amblyopia therapy.
When to refer:
1.
Today -if abnormal red reflex, abnormal
pupillary reaction, significant decrease in vision.
2.
Near Future- A squint is found or suspected and
the cause is unknown.
Management on Referral:
1.
Visual
acuity.
2.
Cover
Test and examine eye movements
3.
Cycloplegic
refraction
4.
Examination
following dilatation of pupils.
Incorrect Assumptions:
1.
Child
will grow out of squint. -
-This does not occur for true constant esotropia. (note poor intermittent alignment in 0-3 months does occur with spontaneous improvement)
-Intermittent Exotropia
(divergent squint) can recover spontaneously. But beware of exotropia in 0-2
years as this may herald poor vision due to an organic cause- (Tumour or
cataract).
2.
Strabismus
cannot be treated at an early age.- Early management of strabismus in first
months of life improves the chance of obtaining strereopsis and makes for
better amblyopia therapy.
Rules:
If strabismus is seen or suspected
all serious aetiological factors must be excluded and therapy commenced
promptly.
When esotropia is excluded on
examination believe examination.
When exotropia is described by
parents believe parents not the exam.
CAUSES OF AMBLYOPIA
Esotropia
