Pediatric Ophthalmology and Strabismus
This domain tests amblyopia, strabismus, leukocoria, ROP, congenital glaucoma, and nasolacrimal duct obstruction. The exam emphasizes early diagnosis and prevention of permanent visual loss.
Core pediatric ophthalmology
- Amblyopia: occurs during the critical period; treat the refractive error first, then use patching or atropine.
- Strabismus: cover test and Hirschberg estimate deviation; accommodative esotropia is linked to hyperopia; congenital esotropia presents early; intermittent exotropia is common.
- Leukocoria: retinoblastoma, congenital cataract, ROP, Coats disease, and toxocara. Urgent workup is mandatory.
- ROP screening: infants under 32 weeks or under 1500 g; stages 1–5; plus disease requires laser or anti-VEGF.
- Congenital glaucoma: tearing, photophobia, and buphthalmos; examine under anesthesia and proceed to surgery.
- Nasolacrimal duct obstruction: conservative management until about 1 year, then probing.
Worked example
A 2-year-old has esotropia and +5.00 D hyperopia. Reasoning: accommodative esotropia. Glasses may fully align the eyes; add amblyopia therapy if needed.
Traps
Leukocoria is not just a cataract. Pseudoesotropia has a normal cover test. Do not delay ROP screening.