Snapshot A 12-month-old girl presents to the pediatrician for a well-baby visit. The child is cooperative and playful. On physical examination, the boy has a head tilt. Deflection is noted on corneal light reflex testing, and cover test shows refixation of the left eye when the other eye is covered. Introduction Abnormal visual development → decreased visual acuity visual stimulation is highly important for maturation of the visual cortex ETIOLOGY Can divided into three etiologies: strabismus (most common) leads to the generation of images that cannot be fused properly login to view 1 more bullet refractive error (second most common) leads to differences in image clarity visual deprivation e.g., cataracts Presentation Depends on the cause strabismus esotropia login to view 1 more bullet exotropia login to view 1 more bullet pseudostrabismus login to view 3 more bullets refractive error abnormal vision screening visual deprivation e.g., cataracts login to view 1 more bullet Treatment Correct underlying cause is the initial step strabismus eye realignment via glasses or surgery in severe cases refractive error refractive correction with glasses visual deprivation remove insult login to view 1 more bullet Patching or optic penalization patching occluding the "better" eye to encourage use of the amblyopic eye optic penalization atropine, a cycloplegic, is added to the "better" eye both are equally effective