Pediatric Ophthalmology and Strabismus
Core concepts
Understand visual development and amblyopia: critical period, deprivation versus strabismic amblyopia, and treatment with patching or atropine. Know strabismus types: esotropia (infantile, accommodative), exotropia (intermittent), and vertical deviations. Master the cover-uncover test and alternate cover test for tropia versus phoria. Know leukocoria causes: retinoblastoma, congenital cataract, and persistent fetal vasculature. Understand retinopathy of prematurity screening criteria and treatment with laser for type 1 disease. Know congenital glaucoma (buphthalmos, cloudy cornea, tearing) and its urgency.
Traps
Questions test that a child with leukocoria needs urgent evaluation for retinoblastoma. Another trap: distinguishing accommodative esotropia (treated with glasses) from infantile esotropia (surgery). Also know that amblyopia treatment works best before age 7-8.
Worked example / rule of thumb
A 3-year-old has an inward deviation that is constant and present since birth. That is infantile esotropia, requiring surgery, not just glasses. Rule of thumb: leukocoria in a child equals urgent retinoblastoma workup.