5-year-old girl with new-onset eye misalignment
Pediatric Ophth/Strabismus
What is your diagnosis?
The diagnosis is...
The image is consistent with a diagnosis of exotropia:
- Exotropia is an eye misalignment in which 1 eye is deviated outward, or temporally.
- The deviation is often intermittent but can be constant, and it can affect only 1 eye or may alternate between the 2 eyes.
- If exotropia is constant in infancy, testing for neurological associations should be considered.
- Treatment involves preventing or treating amblyopia and improving the control and angle of misalignment to improve eye contact and binocularity.
What is the role of the primary care or emergency medicine physician?
- Perform visual screening exams in infancy and periodically throughout childhood at well-child visits.
- If exotropia is noted by caregivers or a primary care physician, refer the patient to an ophthalmologist due to concern of amblyopia development and permanent vision loss.
- If abnormal extraocular motility, nystagmus, or an abnormal red reflex is seen, referral is urgent.
What is the role of the ophthalmologist?
The role of the ophthalmologist includes the following:
- determining visual acuity
- assessing for motility defects in the primary gaze and 6 cardinal positions
- assessing eye alignment measurements at near, distance, and cardinal positions of gaze
What is the treatment?
Nonsurgical treatments include correction of refractive error (generally myopia) and over-minus therapy (glasses that are more myopic than the patient's refraction). Patching 1 eye can help improve control of the drifting, and patching or pharmacologic penalization of the sound eye can be used to treat amblyopia.
Surgical treatment may be performed on the extraocular muscles in an attempt to restore ocular alignment.
Learn more: Ophthalmology resources for medical students