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Pediatric Ophthalmology and Strabismus

What types of examinations do pediatric ophthalmologists provide?

  • Vision assessment- it takes particular skills to test a child’s eyesight, especially in the pre-school child. Different methods are used for different ages.

  • Determination of refractive error (the need for and strength of glasses) - this testing is performed after dilation in most pediatric patients to ascertain an objective measurement.

  • Motility examinations- quantitative measurement of ocular misalignment necessary for planning medical and surgical management of strabismus.

  • Biomicroscopy and dilated fundus examinations- to investigate the presence of eye disease associated with systemic disease (e.g. diabetes, JIA, genetic abnormalities, neurological pathology (increased intracranial pressure) or ocular disease (e.g. cataracts, glaucoma).

  • Examination under anesthesia (EUA)- for diagnostic and/or therapeutic intervention.

  • Monitor diseases over time and assess the efficacy of treatment.

What kinds of treatments do pediatric ophthalmologists provide?

  • Medical treatments

  • Presciptions for glasses and/or contact lenses

  • Amblyopia (“lazy eye”) therapy including glasses, patching and pharmacological treatment

  • Topical and or/systemic therapy for eye infections, chalazia, glaucoma, blocked tear ducts, and inflammations.

  • Medicines include antibiotics, antivirals and steroids.

  • Surgical Procedures

  • Probe and Irrigation for congenital nasolacrimal duct obstruction (blocked tear ducts)

  • Excision of chalazia

  • Eye muscle surgery for strabismus

  • Pediatric cataract extraction including use of intraocular lenses (IOLs)


NOTE: not all practitioners perform all medical and surgical treatments. Variability is due to the training, experience and interest of the individual pediatric ophthalmologist. Additional treatments/surgeries performed by some include examination and laser treatment of ROP, surgical removal of pediatric orbital lesions, and surgery for glaucoma or ptosis in the child.​


What is strabismus and how common is it?
Strabismus is any misalignment of the eyes. It is estimated that 4% of the U.S. population has strabismus.

Are there different types of strabismus and if so, how are they named?
There are many different types of strabismus. Strabismus is most commonly described by the direction of the eye misalignment; common types of strabismus are esotropia, exotropia, hypotropia, and hypertropia.

Strabismus can also be described by its cause. The 3 cranial nerves (III, IV, VI) responsible for eye movement can be weak or palsied and cause strabismus. Some examples of paralytic strabismus include third nerve palsy and superior oblique palsy.

Special patterns of strabismus can have unique names such as Brown syndrome, and Duane syndrome.

What are the types of horizontal strabismus?
Esotropia is inward turning of the eyes (aka "crossed eyes"). Types of esotropia include infantile esotropia, accommodative esotropia, and sixth nerve palsy. Exotropia is the term used to describe outward turning of the eyes (aka "wall-eyed")

What are the types of vertical strabismus?
The terms hypertropia and hypotropia are used to describe vertical misalignment. Hypertropia is an abnormal eye higher than the normal eye. Hypotropia is when the abnormal eye is lower than the normal eye. The terms can generally be interchanged.

What causes strabismus?
Most strabismus is the result of an abnormality of the poorly understood neuromuscular (including brain) control of eye movement. Less commonly, a problem with the actual eye muscle causes strabismus.

How is strabismus related to poor vision?
Eye misalignment can cause amblyopia in children. When the eyes are oriented in different directions, the brain receives 2 different visual images. The brain may ignore the image from the misaligned eye to avoid double vision, resulting in poor vision development of that eye. Also, an eye that sees poorly tends to be misaligned.

Who develops strabismus as a child?
Strabismus often occurs in children who are otherwise completely normal. However, disorders that affect the brain such as cerebral palsy, Down syndrome, hydrocephalus and brain tumor are more likely to develop strabismus.

What adult disorders cause strabismus?
Stroke is the leading cause of strabismus in adults. Trauma, neurological problems, and Graves disease (thyroid eye disorders) are other common causes of strabismus.

How does trauma cause strabismus?
Trauma can cause strabismus by 1) brain damage that impairs control of eye movement, 2) damage of the nerves that control eye movement and/or 3) damage of the eye muscles either directly or secondarily from trauma to the eye socket.

How is strabismus treated?
The goal of strabismus treatment is to improve eye alignment which allows for better work together (binocular vision). Treatment may involve eye glasses, eye exercises, prism, and/ or eye muscle surgery. Problems associated with strabismus (including amblyopia, ptosis, and cataract) are usually treated prior to eye muscle surgery.

Source: American Association for Pediatric Ophthalmology and Strabismus,

Source: American Academy of Ophthalmology,

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