The Ophthalmology
Survival Guide
Strabismus
Strabismus is a misalignment of the eyes, which are normally tightly linked to each other so that binocular vision can be maintained.
Strabismus limits or prevents fusion, the formation of a single image in the brain by combining the separate images coming from each eye.
Survival Tips!
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Evaluations of eye alignment are a critical survival skill, as abnormalities can be a sign of serious, and occasionally life-threatening pathology.
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Use the Hirschberg test or alternate cover test for these evaluations.
Symptoms to look for:
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Diplopia, or double vision, is the symptom that most strongly suggests an abnormality of eye alignment, but it may not always be present (e.g. very young children often do not complain of diplopia, even when there is an acute onset of strabismus).
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The presence of strabismus without diplopia generally (but not always) suggests something more longstanding and less worrisome.
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The presence of a habitual head tilt or face turn is suggestive of strabismus.
Remember:
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When documenting extraocular movement (EOM) and eye alignment, the presence and type of strabismus should be noted.
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Strabismus can be acquired, which is generally a bad thing. It suggests that something dysfunctional is going on with the brain, the cranial nerves controlling EOMs, the EOMs themselves, or occasionally the retina.
Emergency Care To Note
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Remember, the key to survival is to recognizing red flags, and taking the appropriate steps to evaluate them without undue delay. Acute onset strabismus is a red flag.
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Retinoblastoma most often present as a new onset strabismus secondary to vision loss.
