Summary
Definition
History and exam
Key diagnostic factors
- diplopia
- eye misalignment
- amblyopia
Other diagnostic factors
- abnormal eye movements
- visual confusion
- asthenopia
- intermittent closure of one eye
- cranial nerve palsy
Risk factors
- family history of strabismus
- prematurity
- low birth weight
- maternal smoking during pregnancy
- refractive error
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
Investigations to consider
- version testing
- duction testing
- forced duction testing
- CT or MRI of orbit
- MRI of brain
- CT chest
Treatment algorithm
primary strabismus
secondary strabismus
Contributors
Authors
Daniel J. Salchow, MD

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.
Differentials
- Pseudostrabismus
- Blurred vision
- Monocular diplopia
More DifferentialsGuidelines
- Pediatric ophthalmology/strabismus summary benchmarks 2021
- Pediatric ophthalmology/strabismus summary benchmarks - 2021
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