Misalignment of the visual axes of the eyes; may be latent or manifest and, if manifest, it may be constant or intermittent.
Common cause of diplopia (double vision) and visual confusion (seeing different objects in the same place) in adults.
Important cause for amblyopia (decreased vision in an anatomically normal eye caused by suppression) in children.
May be esthetically obvious to the patient and others, resulting in psychosocial problems.
Evaluation involves a detailed medical history, including a complete ocular history, followed by thorough neurologic and ophthalmic examinations.
Treatment is directed at restoring and maintaining ocular alignment, eliminating diplopia or visual confusion, enabling binocular vision, and restoring normal appearance.
If strabismus is secondary to an underlying cause (e.g., abducens nerve [cranial nerve VI] palsy causing esotropia), treatment of this condition is necessary.
Strabismus refers to a misalignment of the eyes. If strabismus develops in adults, it can cause diplopia (double vision) and visual confusion (seeing different objects in the same location), and it is an important cause of amblyopia in children. Whereas normally both eyes fixate (look at) the object of interest, in strabismus one eye fixates and the other (nonfixating eye) is deviated.
History and exam
Key diagnostic factors
- eye misalignment
Other diagnostic factors
- abnormal eye movements
- visual confusion
- intermittent closure of one eye
- cranial nerve palsy
- family history of strabismus
- refractive error
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
Daniel J. Salchow, MD
Pediatric Ophthalmology; Strabismus; Neuro-ophthalmology
DJS declares that he has no competing interests.
Robert B. Avery, MD, PhD
Assistant Professor of Ophthalmology
Department of Surgery
University of New Mexico School of Medicine
RBA declares that he has no competing interests.
Peter Tiffin, BMedSci(Hons), MBBS, FRCOphth
City Hospitals Sunderland
PT declares that he has no competing interests.
Jonathan Smith, MBBS, MRCP, MRCOphth
Specialist Registrar in Ophthalmology
Royal Victoria Infirmary
JS declares that he has no competing interests.
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