A current summary of strabismus in children

Abstract

Summary<ul><li>1.Only the pediatrician, and to a lesser degree the family physician and the optometrist, can change the public conception that expectant treatment is proper for the squinting child.</li><li>2.The period of opportunity for development of visual function (birth to age 5 to 6 years) will be used, squint or no squint. With strabismus it will be devoted to the perfection of some abnormal, inferior type of two-eyed function, which in time becomes fixed and irreversible—"right" for the particular case.</li><li>3.The functional cure of squint—the attainment of binocular single vision—is difficult of realization, and is rarely achieved unless the squinting child is seen early by the ophthalmologist.</li><li>4.Functionally perfect straight eyes are not possible for all children. Only some 60 to 65 per cent of squinters have even a potentiality of binocular single vision, as of current methods of treatment.</li><li>5.Functional cure demands the presence or creation of similarity and congruity in the binocular mechanism —a similarity of images for fusion and a congruity of muscles for motility. Also necessary is an early and continuing opportunity for this symmetrical binocular machinery to learn to function as a unit.</li><li>6.Good vision in each eye is thesingle most important prerequisite to maintaining a normally straight pair of eyes, or aligning a pair of squinted ones.</li><li>7.Orthoptics ("eye exercises")should be hopefully undertaken only in selected strabismus cases. It is rarely of value unless accompanied by other forms of squint therapy as occlusion, glasses, and surgery, and cannot be used until the child has reached an age which of itself makes functional cure of squint unlikely.</li><li>9.Unless binocular single vision is potentially achievable, and unless parents, child, and ophthalmologist are ready to expend a maximum, sustained, and often expensive effort to obtain it, it is better to defer a merely cosmetic surgery until kindergarten age. Operations that are merely cosmetic suffer losses of straightness in time.</li></ul>