Pediatric Ophthalmology and Strabismus
Core concepts
Understand visual development and the critical period for amblyopia. Know the types of strabismus (esotropia, exotropia, hypertropia), the cover test and Hirschberg estimation, and the accommodative esotropia (hyperopia-driven, responds to glasses). Know amblyopia types (strabismic, refractive, deprivation) and treatment (patching, atropine). Understand congenital cataract, retinopathy of prematurity (staging, screening criteria), and congenital glaucoma (buphthalmos, corneal edema).
Traps
A key trap is pseudostrabismus (epicanthal folds) vs. true strabismus - use the cover test. Another is accommodative esotropia - do not operate before trying glasses. Also know ROP screening thresholds (birth weight <1500 g or gestational age <32 weeks).
Worked example
A 3-year-old with inward turning of one eye, hyperopia on cycloplegic refraction. Rule of thumb: accommodative esotropia responds to full hyperopic correction; prescribe glasses and reassess before considering surgery.