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Answers: 2004 series -  August 3, 2004 Lecture 22 of 50  NEXT»

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This 8-month-old girl was brought in by her parents for evaluation of one eye turning in.  The child is otherwise healthy, is not fussy and there is no family history of strabismus.

1.  The examination of this infant should include the following:  
 

d --

When a child is presented with the question "are my child's eyes crossed?", a thorough examination should be done in every case.  This includes assessment of vision, cycloplegic refraction, and examination of the ocular media.  Even if you are confident that this is pseudo strabismus, it is important to complete a thorough examination so as not to miss another hidden problem.  When a child is seen by an ophthalmologist in a situation like this, the family will assume that "everything is OK" even if the examiner only rules out the original problem. 

 

2.  The clinical picture in this child suggests the following: 
 

a --

Pulling the skin between the eyes forward is a good way of demonstrating to the family that the eyes are not crossed.  Children will usually object to this maneuver, but it can be very useful.  It is unlikely that this is an esotropia. Careful cover testing in addition to the tests listed above will likely prove this.  Of course, no surgery is indicated.

 

3.  The likely final diagnosis in this case would be:
 
c --

The most likely diagnosis is pseudo strabismus.  Of course, the tests above must be done and interpreted properly to confirm this diagnosis.  Doll's head testing is important in cases like this to confirm full adduction which would rule out Duane syndrome and VI nerve palsy.

 

 
 

Lecture 22 of 50 «Previous Lecture   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50    Next»