By the American Academy of Ophthalmology Preferred Practice Pattern Pediatric Ophthalmology/Strabismus Panel: David K. Wallace, MD, MPH,1 Stephen P. Christiansen, MD,2 Derek T. Sprunger, MD,3 Michele Melia, ScM,4 Katherine A. Lee, MD, PhD,5 Christie L. Morse, MD,6 Michael X. Repka, MD, MBA7
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1 Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana
2 Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts
3 Indiana University Health Physicians, Midwest Eye Institute, Indianapolis, Indiana
4 Jaeb Center for Health Research, Tampa, Florida
5 Pediatric Ophthalmology, St. Luke’s Health System, Boise, Idaho
6 Concord Eye Center, Concord, New Hampshire
7 Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
HIGHLIGHTED FINDINGS AND RECOMMENDATIONS FOR CARE
Strabismus in children under 4 months of age sometimes resolves, 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 the initial prescription of hyperopic refraction or when the esotropia recurs after surgery.
Bilateral lateral rectus recession and unilateral recess-resect are both reasonable strategies for initial surgery of intermittent exotropia.
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.
Children with untreated strabismus can have reduced binocular potential and impaired social interactions, which may affect their interactions and quality of life.
Simultaneous prism and cover testing, which measures the manifest angle of strabismus, and prism and alternate cover testing, which measures the total angle of misalignment, are important elements of binocular testing. Both inform the ophthalmologist’s decisions regarding management and surgical indications.
Convergence insufficiency occurs in children and adults, and symptoms with near viewing (typically reading) can often be improved using vergence exercises.