2-year-old girl with new-onset eye misalignment

The image is consistent with a diagnosis of esotropia:

• Esotropia, or crossing of the eyes, is an eye misalignment in which 1 eye is deviated inward, or nasally.
• The deviation may be constant or intermittent, and it can affect only 1 eye or may alternate between the 2 eyes.
• Treatment involves addressing any underlying cause, preventing or treating amblyopia, and improving the alignment with glasses or surgery.

• Perform visual screening exams in infancy and periodically throughout childhood at well-child visits.
• If esotropia is noted by caregivers or a primary care physician, refer the patient to an ophthalmologist due to concern of amblyopia development and permanent vision loss.
• If a deficit in abduction (moving the eye outward), nystagmus, or an abnormal red reflex is seen, referral is urgent.

The role of the ophthalmologist includes the following:

• determining visual acuity

• assessing for motility defects in the primary gaze and 6 cardinal positions

• assessing eye alignment measurements at near, distance, and cardinal positions of gaze

Nonsurgical treatments include correction of refractive error (especially hyperopia). Patching or pharmacologic penalization of the sound eye can be used to treat amblyopia.

Surgical treatment may be performed on the extraocular muscles in an attempt to restore ocular alignment.

Pediatric Ophthalmology: AAO Interactive Case

Strabismus Simulator

Amblyopia

Leukocoria

Pediatric Eye Examination