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Strabismus Case Report

1. A 6-month-old female infant presented with occasional crossing of her left eye. Her past medical and ocular history were unremarkable. 2. On examination, her left eye was crossed inward while the rest of the exam was normal. She was diagnosed with infantile esotropia of the left eye. 3. Treatment options included corrective lenses for her mild hyperopia, botulinum toxin injections for a small or medium angle esotropia, or early surgery between 6-24 months of age.

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140 views13 pages

Strabismus Case Report

1. A 6-month-old female infant presented with occasional crossing of her left eye. Her past medical and ocular history were unremarkable. 2. On examination, her left eye was crossed inward while the rest of the exam was normal. She was diagnosed with infantile esotropia of the left eye. 3. Treatment options included corrective lenses for her mild hyperopia, botulinum toxin injections for a small or medium angle esotropia, or early surgery between 6-24 months of age.

Uploaded by

byambadorj.mb
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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CASE REPORT

1st year resident Byambadorj


Munkhbayar
Patient visit

A 6 month-old female infant. Came with her brother.


CC: Crossed eyes
Patient visit

• Occasional crossing of her eyes.


• L>R
• Responds to light, tracks faces, and plays with toys
without issue.
Patient history

• Past ocular history: None • Past family ocular history: Mother


• Ocular medication: None with refractive error, maternal uncle
with lazy eye.
• Past medical history: Born at term
• Social history: Lives at home with
• Surgical history: None mom and dad. No smokers in home.
• Medication: None
• Allergies: None
Examination
• External: Her left eye is crossed inward. Face is symmetric.
• EOM: Full OU, no nystagmus
• CVF: Responds to light directed in four quadrants with each eye
Examination
Ocular exam
VA Fixes and follows OU
IOP Ocular exam Soft by palpation OU
Pupils Equal, round and reactive to light, no APD. No
leukocoria OU
Lids and Lashes Normal OU
Conjunctiva/Sclera Normal OU
Cornea Clear OU
Anterior Chamber Grossly normal
Iris Normal OU
Lens Clear OU
Anterior vitreous Clear OU
Dilated fundus examination Clear view, CDR 0.2 with sharp optic disc margins,
no optic nerve hypoplasia, flat macula with normal
foveal light reflexes, normal vessels OU
Other

• Stereopsis: Unable to determine given patient age.


• Retinoscopy: mild hyperopia OU (+1.00) without astigmatism
Dx

Infantile esotropia of the left eye


DDx

• Pseudostrabismus
• Accomodative esotropia
• CN6 palsy
Management

• Correction of recractive error:


Corrective lenses are often prescribed if the hyperopia is greater than 2.50 diopters and/or
when there is 1.50 diopters or more of anisometropia.

• Surgery (<40D):
Timing of surgery: Early (6-24 months) vs Delayed (32-60 months)

• Medical therapy:
Botulinum toxin (small and medium angle esotropia)
Thank you
Thank You

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