Review Question - QID 219718

This patient who presents with a gaze deviation (resolving with temporary patching) and an abnormal light reflex most likely has strabismus. Eye patching is required to prevent the development of amblyopia.

Strabismus describes congenital or acquired misalignment of the eyes that can be
horizontal, vertical, or torsional. It occurs idiopathically in 2% of the population though risk factors include family history, low birth weight, or visual deprivation. On physical exam, patients will have eye misalignment, asymmetric corneal light reflex, refixation of the uncovered eye with the cover test, and relatively intense red reflection on the deviated eye. Strabismus is a clinical diagnosis though neuroimaging for children with underlying neurologic disorders may be required. Treatment is typically with occlusive therapy to promote the development of the deviated eye. Complications of untreated strabismus are amblyopia, diplopia, and psychosocial impairment.

Ticho reviews the evidence regarding the diagnosis and treatment of strabismus. He discusses how this condition is associated with asymmetric visual development in children if left untreated. He recommends treatment with eye patching.

Figure/Illustration A is a clinical photograph of a child with a deviation of the right eye (red circle). This finding is consistent with strabismus.

Incorrect Answers:
Answer 1: Antibiotics can be used in patients who present with neonatal ophthalmological infections such as Neisseria gonorrhea. This disease would present with purulent discharge shortly after birth that is associated with redness and pain.

Answer 3: Observation is appropriate for patients who have symmetric eye gaze and mildly delayed developmental milestones. Patients who have strabismus should be treated to decrease the risk of developing amblyopia.

Answer 4: Occupational therapy is appropriate for patients who have delayed developmental milestones to allow for increased social and physical functioning. It would not be used in isolation in patients with strabismus as these patients require eye patching to prevent the development of amblyopia.

Answer 5: Surgery is appropriate for patients who have neonatal cataracts. Cataracts can be an underlying cause of strabismus. This condition would present with the absence of a red reflex in the affected eye as well as a white mass on an ophthalmological exam.

Bullet Summary:
Strabismus should be treated with eye patching in order to decrease the risk of developing amblyopia.