BACKGROUND
Strabismus (squint) is a condition in which the eyes are misaligned. While one eye is directed at an object, the other eye may turn in (esotropia), out (exotropia), up (hypertropia), or down (hypotropia). This misalignment may be persistent or intermittent. Newborn babies may have evidence of intermittent horizontal strabismus, which may be normal.
Any baby who continues to suffer from strabismus beyond the age of 3 months should be referred to secondary care for further investigations. The overwhelming majority of squints in children will be benign and can be referred for further investigation on a routine basis. However, if there are any red flags (Box 1) the child should be referred urgently (within a few days) to a hospital eye department (not an optician).
Red flags
Strabismus could be a sign of coexisting ocular pathology, for example, retinoblastoma or intracranial pathology, as where there is a tumour requiring urgent management. If this is suspected then an urgent specialist opinion should be obtained.
Other red flags are:
abnormal red reflex;
limited abduction;
double vision;
headaches;
nystagmus (involuntary, repetitive, side-to-side oscillation of the eyes);
face turned to the side; and
other neurological features — strabismus can be associated with neurological disease such as cerebral palsy.
Finding abnormal neurological signs should prompt referral to a paediatrician.
IMPORTANCE OF RAPID DIAGNOSIS
Timely referral and diagnosis is important because strabismus can be a sign …