Case 1 answers

A 28 year old mum brings her 2 year old daughter, Sophie, into see you. Mum has noticed a squint when Sophie is concentrating on things up close for the last couple of months. She tells you that Sophie’s dad had a squint as a child and wears glasses. You examine the child and confirm a convergent squint.

Some Questions

  1. How would you examine a child with a squint?
  2. Is squint and strabismus the same thing?
  3. Is it important to differentiate between a paralytic and non-paralytic squint?
  4. What is the most common cause of childhood squint?
  5. Does a child with squint have diplopia?
  6. Should you refer this child or watch and wait?
  7. If you were to refer, would it be to an Optometrist or an Ophthalmologist?
  8. What is the difference between an orthotist and an orthoptist?

Answers:

  1. When referring a squint, very little examination is required except a basic check to see if you can confirm the presence of the squint. I would simply observe the child during the consultation and refer based on the history combined with this observation.
  2. Yes, although squint can have other meanings, such as closing eyes to bright light.
  3. No. It is important for someone to differentiate, but this is actually a difficult skill and can be left to the orthoptist/ophthalmologist
  4. Longsightedness (hypermetropia). When a child try’s to focus on objects, especially near objects, the focus mechanism combines with the convergence mechanism to cause a squint. Spectacles are the main treatment
  5. No, because they suppress the second image, and therefore risk amblyopia in the suppressed eye. If the squint ‘alternates’ between eyes this is less likely, but if one eye is always the squinting eye, then amblyopia is common.
  6. Refer all squints. Causes of squint include retinoblastoma.
  7. An ophthalmologist. They require formal assessment with an orthoptist, an ophthalmologist and usually an optometrist too. Refer to an ophthalmologist who will arrange this.
  8. Feet vs Eyes. lots of redirected post between the two departments!

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