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Strabismus

Last reviewed: 1 Oct 2024
Last updated: 22 Sep 2023

Summary

Definition

History and exam

Key diagnostic factors

  • diplopia
  • eye misalignment
  • amblyopia
Full details

Other diagnostic factors

  • abnormal eye movements
  • visual confusion
  • asthenopia
  • intermittent closure of one eye
  • cranial nerve palsy
Full details

Risk factors

  • family history of strabismus
  • prematurity
  • low birth weight
  • maternal smoking during pregnancy
  • refractive error
Full details

Diagnostic tests

1st tests to order

  • cover test
  • simultaneous prism and cover test (SPCT)
  • uncover test (UCT)
  • alternate prism cover test (APCT)
  • Hirschberg test
  • Krimsky test
Full details

Tests to consider

  • version testing
  • duction testing
  • forced duction testing
  • CT or MRI of orbit
  • MRI of brain
  • CT chest
Full details

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

    • Esotropia and exotropia preferred practice pattern
    • Pediatric ophthalmology/strabismus summary benchmarks - 2022​
    More Guidelines
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