What initial management strategies can be employed for a patient with newly diagnosed strabismus?

For a patient with newly diagnosed strabismus, particularly in children, the initial management strategy primarily involves prompt referral to specialist services NICE CKS.

• Referral to Paediatric Eye Service: Any child with a suspected or confirmed squint should be referred to the local paediatric eye service NICE CKS. For most children, a routine referral is indicated NICE CKS. Early initiation of treatment is crucial to prevent or mitigate amblyopia (lazy eye) NICE CKS.
• Urgent or Immediate Referral for Red Flags: If a serious underlying condition is suspected as the cause of the squint, the child should be referred urgently to an ophthalmologist or other appropriate paediatric specialist NICE CKS. Specific red flags necessitating urgent or immediate referral include:
  • Limited abduction, double vision, headaches, or nystagmus NICE CKS.
  • New-onset squint accompanied by loss of fundal ('red') reflex in one or both eyes, requiring immediate referral to ophthalmology services NICE NG127.
  • New-onset squint occurring with ataxia, vomiting, or headache, requiring immediate referral to acute paediatric services NICE NG127.
  • Paralytic squint, which warrants urgent neurological assessment even without other signs of raised intracranial pressure NICE NG127.
• Consideration for Adults and Older Children: For older children and adults with squints, referral with a view to corrective surgery is an option, even if the squint has been present since early childhood NICE CKS.