Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
For a child with suspected strabismus (squint), the recommended referral criteria to a specialist depend on the presence of red flags or specific associated symptoms.
- Routine Referral:
- Any child with a suspected or confirmed squint should be referred to the local paediatric eye service NICE CKS.
- A routine referral is indicated for most children NICE CKS.
- Children with non-paralytic squint should be referred to ophthalmology services NICE NG127.
- Urgent or Immediate Referral (Red Flags):
- Refer the child urgently to an ophthalmologist or other paediatric specialist if a serious underlying condition is suspected as the cause of the squint NICE CKS.
- Urgent referral (within a few days) is indicated in the presence of red flags such as double vision or headaches NICE CKS. Other red flags include limited abduction and nystagmus (involuntary, repetitive, side-to-side oscillation of the eyes) NICE CKS.
- Immediate referral to ophthalmology services is required for children with new-onset squint that occurs together with loss of fundal ('red') reflex in one or both eyes NICE NG127. This also relates to considering referral for ophthalmological assessment using a suspected cancer pathway for retinoblastoma NICE NG12.
- Immediate referral to acute paediatric services is necessary for children with new-onset squint that occurs together with ataxia, vomiting, or headache NICE NG127.
- Urgent referral for neurological assessment is needed for children with paralytic squint, even without other signs and symptoms of raised intracranial pressure NICE NG127.
Early treatment for squint can improve outcomes and help prevent or reduce the worsening of amblyopia (lazy eye) NICE CKS.