2-year-old girl with new-onset eye misalignment
What is your diagnosis?
The diagnosis is...
The image is consistent with a diagnosis of esotropia:
What is the role of the primary care or emergency medicine physician?
- 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.
What is the role of the ophthalmologist?
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
What is the treatment?
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.
Learn more: Ophthalmology resources for medical students