Pediatric Ophthalmology and Strabismus
Core concepts
Understand visual development and the critical period; amblyopia arises from deprivation, strabismus, or anisometropia, and treatment is most effective early. Know the types of strabismus: esotropia (infantile, accommodative, acquired), exotropia (intermittent, sensory), and vertical deviations. Learn the cover test, alternate cover test, and the role of cycloplegic refraction.
Know the red flags in a child: leukocoria (retinoblastoma, cataract, Coats), white reflex, poor fixation, nystagmus, and asymmetric red reflex. Understand retinopathy of prematurity screening based on gestational age and birth weight.
Traps
- Missing amblyopia because the child has straight eyes (anisometropic).
- Not performing cycloplegic refraction in a child with esotropia.
- Confusing congenital esotropia with accommodative esotropia (glasses response).
- Overlooking leukocoria as a sign of retinoblastoma.
Rule of thumb
Any child with strabismus needs a cycloplegic refraction; and leukocoria is retinoblastoma until proven otherwise.
Worked example
A 4-year-old with intermittent inward deviation, worse when tired, and hyperopia on cycloplegic refraction. This is accommodative esotropia; full hyperopic correction often aligns the eyes and prevents amblyopia.