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 ¹.

• Referral to Paediatric Eye Service: Any child with a suspected or confirmed squint should be referred to the local paediatric eye service ¹. For most children, a routine referral is indicated ¹. Early initiation of treatment is crucial to prevent or mitigate amblyopia (lazy eye) ¹.
• 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 ¹. Specific red flags necessitating urgent or immediate referral include:
  • Limited abduction, double vision, headaches, or nystagmus ¹.
  • New-onset squint accompanied by loss of fundal ('red') reflex in one or both eyes, requiring immediate referral to ophthalmology services ⁴.
  • New-onset squint occurring with ataxia, vomiting, or headache, requiring immediate referral to acute paediatric services ⁴.
  • Paralytic squint, which warrants urgent neurological assessment even without other signs of raised intracranial pressure ⁴.
• 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 ¹.