Pediatric Ophthalmology and Strabismus
This section covers paediatric ophthalmology and strabismus: amblyopia, ocular alignment, refractive adaptation, and surgical timing. The exam tests sensory and motor assessment in children.
Core rules and concepts
- Amblyopia is reduced vision from abnormal visual experience; causes include strabismus, anisometropia, and deprivation. Treatment is correction of the cause, patching, or atropine penalisation.
- The cover test detects manifest and latent deviation; Hirschberg and Krimsky tests estimate angle when cover testing is not possible.
- Accommodative esotropia presents in hyperopic children and is treated with full cycloplegic correction; residual esotropia may need surgery.
- Congenital esotropia presents before 6 months with a large angle; it needs early surgery after excluding retinoblastoma and other causes.
- Intermittent exotropia is common and may be observed; surgery is considered for poor control or progression.
Worked example
A 4-year-old has inward turning of one eye. Cycloplegic refraction is +5.00 D in both eyes, and the cover test shows a 20-prism-diopter esotropia at distance and near. The diagnosis is accommodative esotropia. Prescribe full spectacle correction and review in 6 weeks. If the deviation resolves, glasses are continued; if amblyopia persists, patching is added. Surgery is reserved for residual non-accommodative esotropia after glasses. Fundus examination excludes structural causes.
Traps that cost marks
Never diagnose strabismus without checking the fundus and red reflex; leukocoria is retinoblastoma until excluded. Do not prescribe glasses without cycloplegia in a child. Patching requires compliance and monitoring for occlusion amblyopia in the fellow eye. Early surgery for congenital esotropia improves binocular potential.