Published on 21/03/2015 by admin
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Last modified 21/03/2015
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Chapter 41 STRABISMUS
Theodore X. O’Connell
Strabismus refers to ocular misalignment and is one of the most common reasons for referral of pediatric patients to ophthalmologists. Strabismus includes a heterogeneous group of eye movement problems ranging from constant to latent, and from congenital to those acquired late in life. The ocular misalignment present in strabismus interferes with the development and use of normal binocular vision and results in permanent loss of stereopsis (depth perception) if the eyes are not realigned early in development. Strabismus may also interfere with the ability to fix visually on objects of regard and to follow moving objects.
Before 6 weeks of age, coordination of eye movements is poor, and the eyes in normal infants may be misaligned. In fact, the eyes of most children are mildly exotropic (deviating outward). By the age of 3 months, infants’ alignment is stable, and abnormalities of alignment may be diagnosed more accurately. Any strabismus occurring after age 3 months is abnormal.
Infantile strabismus is defined as constant misalignment present before 6 months of age. Infantile strabismus includes infantile esotropia (inward deviation) and exotropia (ouward deviation).
Infantile esotropia is not always observed at birth but is readily apparent by three months of age. There is frequently a family history of strabismus, and this type of strabismus is not usually associated with any other neurologic or developmental problems. Infants with congenital esotropia must be treated before two years of age for optimal visual outcome. Therefore, early detection and treatment of strabismus are essential to maximize potential visual function. The treatment for infantile esotropia usually consists of surgery to realign the eyes. Early surgical realignment appears to result in better outcomes than does later intervention.
Infantile exotropia is much less common than esotropia and is seen frequently in association with cerebral palsy, prematurity, structural abnormalities in an eye, craniofacial syndromes, and other neurodevelopmental conditions. Any exotropia that occurs after the age of 4 months is abnormal. The treatment of infantile exotropia also consists of surgery to realign the eyes, though the outcomes depend on the associated conditions.
Accommodative esotropia (also known as acquired esotropia
Instant Work-ups A Clinical Guide to Pediatrics
