Strabismus and ocular motility disorders — branching viva

Opening question

A three-year-old has a constant inward-turning right eye, an angle that is the same in every direction of gaze, reduced acuity in the right eye and a hyperopic cycloplegic refraction. What is the diagnosis, which test confirms it and drives the first treatment, and what is the fixed sequence of management? [1] [5]

Branch 1 — the amblyopia-first principle

The right eye has reduced acuity. State the two main amblyopia treatment options, how they compare for moderate amblyopia, and the principle that governs their timing relative to strabismus surgery. Why is operating on an eye that still suppresses futile for binocular fusion? [9] [1]

Branch 2 — the incomitant red flag

Now an eight-year-old presents with sudden double vision, a left eye that cannot abduct, and an esodeviation much worse looking to the left and at distance. Classify this deviation, name the likely localising diagnosis, the serious causes you must exclude, and the urgent investigation. Why is this child's plan fundamentally different from the first child's? [6] [1]

Branch 3 — the infant and the illusion

A one-year-old is referred for a turned eye. The child has broad epicanthal folds, a normal cover test and symmetrical corneal light reflexes. What is the diagnosis, and what single bedside test resolves it? What must you always perform at the first visit in any infant with a suspected turn, and which sight- or life-threatening cause does it exclude? [1]

Closing — coordination and counselling

In one sentence, what is the principle of childhood strabismus management across the age spectrum, and why does the general paediatrician sit at the centre of detection, the cover test, timely referral and amblyopia adherence support? [1] [5]