Strabismus
Description Diagnostic criteria Referral ICD-10 code: H50.9 DESCRIPTION Strabismus (squint) is a misalignment of the two eyes. A non-paralytic squint (concomitant strabismus): will not have restrictions of ocular movements in any of the eye positions. A paralytic squint (incomitant strabismus): will have a restriction in one or more of the six cardinal eye positions. Consider cranial
Description
Diagnostic criteria
Referral
ICD-10 code: H50.9
DESCRIPTION
Strabismus (squint) is a misalignment of the two eyes.
A non-paralytic squint (concomitant strabismus): will not have restrictions of ocular movements in any of the eye positions.
A paralytic squint (incomitant strabismus): will have a restriction in one or more of the six cardinal eye positions. Consider cranial nerve palsy (III, IV or VI). Do a full neurological examination.
Complications of strabismus
- Amblyopia: a sensory state of an eye where abnormal visual development occurs if that eye is not being used by the brain. Untreated amblyopia leads to permanent visual impairment.
- Diplopia: when a strabismus occurs after the development of binocularity, the child will perceive a sensation of double vision (diplopia). Binocularity develops during the first decade.
DIAGNOSTIC CRITERIA
- The corneal light reflex: Patient is asked to fixate on a light held by the examiner at a distance of 33 cm. The light glistening on the cornea is displaced relative to the pupil.
- The cover test: Cover one eye and then the other. This elicits a re-fixation movement of the non-fixating eye.
REFERRAL
- All children with a squint.
- Urgent: any acute onset of strabismus.
- Within 24 hours: incomitant strabismus.
- Within 1 week: if complications of strabismus are present.
- Within 1 month: concomitant strabismus.
Standard Treatment Guidelines and Essential Medicines List for South Africa Paediatric Hospital _2023, 5th edition_Updated July 2024
Chapter 16: Eye Conditions, 16.11 Strabismus