Rationale

Screening programs for strabismus, as well as parental concern about children with a wandering eye, crossing eye, or poor vision in one eye, require physicians to be able to detect this condition and be familiar with initial management steps. Failure to identify and treat this condition in a timely manner may result in visual defects and psychosocial and vocational consequences.

Causal Conditions

(list not exhaustive)

1. Esotropia (convergent, internal, cross-eye) — congenital and acquired

2. Transient (e.g., presents at less than 4 months of age)

3. Idiopathic (esotropia and exotropia)

4. Neurogenic strabismus (e.g., cranial nerve paresis)

5. Myogenic strabismus (e.g., mechanical restriction, neuromuscular junction defect, muscle disease/inflammation)

6. Sensory strabismus (loss of vision due to organic ocular anomalies causing strabismus)

7. Amblyopia without strabismus

Key Objectives

Given a patient with strabismus and/or amblyopia, the candidate will diagnose the cause, severity, and complications, and will initiate an appropriately timed management plan. In particular, he will determine the type of strabismus and the necessary urgency of intervention, in order to prevent the development of severe amblyopia.

Enabling Objectives

Given a patient with strabismus and/or amblyopia, or a history of risk factors for same, the candidate will

1. identify the risk factors for the development of strabismus or amblyopia in a child (e.g., prematurity, family history);

2. list and interpret key components of the history and physical exam with particular attention to

   1. differentiating pseudo strabismus (e.g., lid configuration) from true strabismus;

   2. conducting a thorough ocular exam including visual acuity if appropriate;

3. construct an effective initial management plan, including

   1. determine if the patient requires further investigation or a referral based on the risk factors or the clinical findings;

   2. counsel parents about the need for timely referral to manage strabismus in order to prevent the development of amblyopia.