Strabismus

Last reviewed: 7 Nov 2022
Last updated: 11 Oct 2022

Summary

Definition

History and exam

Key diagnostic factors

  • diplopia
  • eye misalignment
  • amblyopia
More key diagnostic factors

Other diagnostic factors

  • abnormal eye movements
  • visual confusion
  • asthenopia
  • intermittent closure of one eye
  • cranial nerve palsy
Other diagnostic factors

Risk factors

  • family history of strabismus
  • prematurity
  • low birth weight
  • maternal smoking during pregnancy
  • refractive error
More risk factors

Diagnostic investigations

1st investigations to order

  • cover test
  • simultaneous prism and cover test (SPCT)
  • uncover test (UCT)
  • alternate prism cover test (APCT)
  • Hirschberg test
  • Krimsky test
More 1st investigations to order

Investigations to consider

  • version testing
  • duction testing
  • forced duction testing
  • CT or MRI of orbit
  • MRI of brain
  • CT chest
More investigations to consider

Treatment algorithm

ACUTE

primary strabismus

secondary strabismus

Contributors

Authors

Daniel J. Salchow, MD
Daniel J. Salchow

Director

Pediatric Ophthalmology; Strabismus; Neuro-ophthalmology

Charité-Universitätsmedizin Berlin

Berlin

Germany

Disclosures

DJS declares that he has no competing interests.

Peer reviewers

Robert B. Avery, MD, PhD

Assistant Professor of Ophthalmology

Department of Surgery

University of New Mexico School of Medicine

Albuquerque

NM

Disclosures

RBA declares that he has no competing interests.

Peter Tiffin, BMedSci(Hons), MBBS, FRCOphth

Ophthalmology Consultant

City Hospitals Sunderland

Sunderland

UK

Disclosures

PT declares that he has no competing interests.

Jonathan Smith, MBBS, MRCP, MRCOphth

Specialist Registrar in Ophthalmology

Ophthalmics

Royal Victoria Infirmary

Newcastle

UK

Disclosures

JS declares that he has no competing interests.

  • Strabismus images
  • Differentials

    • Pseudostrabismus
    • Blurred vision
    • Monocular diplopia
    More Differentials
  • Guidelines

    • Pediatric ophthalmology/strabismus summary benchmarks 2021
    • Pediatric ophthalmology/strabismus summary benchmarks - 2021
    More Guidelines
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer