Strabismus

H50.9

• Description
• Diagnostic criteria
• Referral

DESCRIPTION

Strabismus (squint) is a misalignment of the two eyes.
A non-paralytic squint (concomitant strabismus): will not have restrictions of ocular movements in any of the eye positions.

A paralytic squint (incomitant strabismus): will have a restriction in one or more of the six cardinal eye positions. Consider cranial nerve palsy (III, IV or VI). Do a full neurological examination.

Complications of strabismus

• Amblyopia: a sensory state of an eye where abnormal visual development occurs if that eye is not being used by the brain. Untreated amblyopia leads to permanent visual impairment.
• Diplopia: when a strabismus occurs after the development of binocularity, the child will perceive a sensation of double vision (diplopia). Binocularity develops during the 1st decade.

DIAGNOSTIC CRITERIA

• The corneal light reflex: Patient asked to fixate on light held by the examiner at a distance of 33 cm. The light glistening on the cornea is displaced relative to the pupil.
• The cover test: Cover one eye and then the other. This elicits a re-fixation movement of the non-fixating eye.

REFERRAL

• All children with a squint.
• Urgent: any acute onset of strabismus.
• Within 24 hours: incomitant strabismus.
• Within 1 week: if complications of strabismus present.
• Within 1 month: concomitant strabismus.