Pediatric emergency medicine trisk 0591 0591
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FIGURE 28.1 Normal extraocular muscle anatomy.
Strabismus With Intact Eye Muscle Function
The remaining types of strabismus fall into the category where eye muscle
function is normal (i.e., nonparetic and nonrestrictive). These problems are not
emergent. The eyes may be misaligned as a result of failure of the brain to use
both eyes simultaneously in a coordinated fashion (idiopathic), a need for
corrective lenses, or the presence of poor vision in one eye. Uncorrected
farsightedness (hyperopia) can result in accommodative esotropia, which may
have an acute onset, usually between the ages of 1 and 6 years, with the
misalignment often worse at near viewing. Uncorrected nearsightedness (myopia)
can result in exotropia, especially when the patient views in the far distance. Both
types of misalignment may be treated with corrective lenses.
Checking the vision in both eyes (see Chapter 123 Ophthalmic Emergencies )
is essential in all cases of strabismus along with full examination of eye
movements to rule out the presence of uncorrected refractive error or a poorly
seeing eye. The latter may be due to serious eye problems such as retinoblastoma
or cataract. Of note, strabismus is the second most common presenting sign of
retinoblastoma after leukocoria.
