Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
When diagnosing strabismus (squint) in children, key clinical features to assess include the type and severity of the squint itself, and the child's visual acuity NICE CKS. It is also important to assess for any underlying cause and to determine if a refractive error is present, as this often coexists with squint NICE CKS,NICE NG62. Assessment should also include looking for any significant abnormal (compensatory) head posture NICE CKS. The aim of management, which guides assessment, also includes maintaining or restoring normal binocular vision NICE CKS. It is crucial to identify if the squint is paralytic or non-paralytic NICE NG127. In children with cerebral palsy, assessment for strabismus is part of the initial ophthalmological and orthoptic assessment, and may involve looking for problems with controlling eye movements NICE NG62.
Specific red flag features that necessitate urgent assessment and referral include:
Specific red flag features that necessitate urgent assessment and referral include:
- Limited abduction of the eye NICE CKS.
- Double vision NICE CKS.
- Headaches NICE CKS,NICE NG127.
- Nystagmus, which is involuntary, repetitive, side-to-side oscillation of the eyes NICE CKS.
- New-onset squint occurring with loss of the fundal ('red') reflex in one or both eyes NICE NG127.
- New-onset squint accompanied by ataxia or vomiting NICE NG127.