My son has a squint, so I’m familiar with treatment of childhood squints. However, I wasn’t previously aware of red flags to look for when children present with a squint:
- Abnormal red reflex
- Limited abduction
- Headaches (the article just says this? Since this is in the context of possible intracranial pathology, I would have thought we’d be assessing the headaches themselves for red flag symptoms)
- Face turned to the side
- Other neurological features
These are because strabismus can be a feature of neurological disease such as cerebral palsy and can also be a sign of intracranial lesions and of ocular pathology such as retinoblastoma.
I also didn’t know that strabismus can show up after birth even in innocent cases; normally it’s within the first three years. They can also be intermittent (in which case check whether dependent on direction of gaze).
Discuss vision; developmental history; family history; frequency and direction of the squint, and which eye, and for how long; and whether diplopia is present. Check eye ROM, red reflexes, and cover test.