Squints in childhood

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
  • Diplopia
  • 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)
  • Nystagmus
  • 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.

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About Dr Sarah

I'm a GP with a husband and two young children.
This entry was posted in Credits 2017, Ophthalmology, Paediatrics. Bookmark the permalink.

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