Obtaining a History in Cases of Strabismus or Torticollis
Both strabismus and torticollis are common presenting complaints to the pediatric ophthalmologist. Torticollis is an abnormal head position (AHP), such as a head turn or tilt. Although torticollis can be caused by a wide variety of ocular and nonocular conditions (discussed later in the chapter) and is not always associated with strabismus, it is a common presenting sign of strabismus. Thus, there is broad overlap in the diagnostic assessment of strabismus and torticollis.
Key questions for the clinician to ask when obtaining a strabismus or torticollis history include the following:
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At what age did the deviation or AHP appear? (Reviewing old photographs may be helpful.)
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Did onset coincide with trauma or illness?
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Is the deviation or AHP constant or intermittent?
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Is it present for distance or near vision or both?
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Is it present only when the patient is inattentive or fatigued?
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Is it associated with double vision or eyestrain?
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If a deviation is noted, is it present in all positions of gaze?
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If a deviation is noted, is it unilateral or alternating?
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Does the patient close 1 eye (squint)?
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Is there a history of other ocular disease or ocular surgery?
The clinician should review previous treatment, including amblyopia therapy, spectacle correction, and eye muscle surgery. The initial assessment should also include observation of the patient’s habitual head position, head movement, and attentiveness. See Chapter 1 for a general discussion of examination of children.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.