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Right medial rectus muscle elongation
2%
1/61
Right lateral rectus muscle resection
Occlusion of the right eye
13%
8/61
Occlusion of the left eye
69%
42/61
Reassurance
Select Answer to see Preferred Response
This infant presents with evidence of strabismus. To minimize progression to amblyopia, the unaffected left eye should be occluded. Strabismus is ocular misalignment in one or both eyes, and it is seen in 3-5% of all children. Cases often present with parental concern about a wandering eye, crossing eyes, or poor vision. If untreated, amblyopia may occur, where the affected eye's visual acuity decreases due to lack of neural stimulation of that eye and increased dependence on the unaffected eye. To "recruit," and encourage use of the affected eye, the unaffected eye is patched or its vision decreased with the use of cycloplegic eye drops. Figure A shows an infant with strabismus. The right eye is directed medially, otherwise called esotropia. Incorrect Answers: Answers 1-2: Right medial rectus muscle elongation or right lateral rectus muscle resection are invasive procedures that may be necessary if visual acuity does not sufficiently improve in the right eye with non-invasive interventions. Answer 3: Occlusion of the right eye would worsen neurodevelopment of the right optic nerve and its associated cortices, exacerbating the onset of amblyopia. Answer 5: Reassurance is inappropriate management of strabismus as it could lead to decreased visual acuity in the affected eye. Bullet Summary: Strabismus can lead to amblyopia and should be managed by occluding the unaffected eye or by pharmacologically decreasing the unaffected eye's visual acuity in order to stimulate use of the affected eye.
3.8
(5)
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