By the American Academy of Ophthalmology Preferred Practice Pattern Pediatric Ophthalmology/Strabismus Panel: Derek T. Sprunger, MD,1
Scott R. Lambert, MD,2
Amra Hercinovic, MPH, Methodologist,3
Christie L. Morse, MD,4
Michael X. Repka, MD, MBA, Consultant,5
Amy K Hutchinson, MD,6
Oscar A. Cruz, MD,7
David K. Wallace, MD, MPH, Chair8
As of November 2015, the PPPs are initially published online-only in the Ophthalmology
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Indiana University Health Physicians, Midwest Eye Institute, Indianapolis, Indiana2
Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California3
Jaeb Center for Health Research, Tampa, Florida4
Concord Eye Center, Concord, New Hampshire5
David L. Guyton, MD and Fednuniak Family Professor of Ophthalmology, Professor of Pediatrics, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland6
Professor of Ophthalmology, Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia7
Anwar Shah Endowed Chair and Professor, Department of Ophthalmology and Department of Pediatrics, Saint Louis University Medical Center, Saint Louis, Missouri8
Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana
Highlighted Findings and Recommendations for Care
Strabismus in children under 4 months of age sometimes resolves without treatment, particularly if the deviation is intermittent, variable, or measures less than 40 prism diopters.
Repeat cycloplegic refraction is indicated when esotropia does not respond to an initial prescription for hyperopia or when esotropia recurs after surgery.
Acquired esotropia should be evaluated and treated promptly.
Young children with intermittent exotropia and good fusional control can be followed without surgery because there is a low rate of deterioration to constant exotropia or reduced stereopsis.
Indications for surgery in intermittent exotropia include a progression to constant or nearly constant deviation, reduced stereopsis, and/or a negative effect on social interactions.
Unilateral recess-resect and bilateral lateral rectus recessions are both effective initial surgical procedures for the treatment of intermittent exotropia.
Convergence insufficiency occurs in children and adults, and symptoms with near viewing can often be improved using vergence exercises.
Simultaneous prism and cover testing measures the manifest angle of strabismus, and prism and alternate cover testing measures the total angle of misalignment. Both inform the ophthalmologist’s decisions regarding management and surgical indications.
Esotropia and Exotropia PPP - 2022 - Literature Search