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Strabismus pp 19–46Cite as

Clinical Evaluation of Strabismus

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Abstract

It is not uncommon in an ophthalmologist’s office to have an anxious couple with the complaint of their child squinting occasionally. Confirming the presence or absence of deviation requires patience and a systematic approach. Even if obvious, the ophthalmologist should not comment on the deviation till completion of examination.

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Author information

Authors and Affiliations

  1. Department of Ophthalmology, King George’s Medical University, Lucknow, India

    Siddharth Agrawal, Ankur Yadav & Neha Singh

Authors
  1. Siddharth Agrawal
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  2. Ankur Yadav
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  3. Neha Singh
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Editor information

Editors and Affiliations

  1. Ophthalmology, King George’s Medical University, Lucknow, Uttar Pradesh, India

    Siddharth Agrawal

Annexure 1: Sample Strabismus Case Sheet

Annexure 1: Sample Strabismus Case Sheet

Patient’s name

Age Sex Occupation

Address & Phone

Orthoptic Clinic registration number

Date of 1st Visit

Chief complaints

Brief history

Other relevant history

 Family/Trauma/Perinatal/Past Treatment/Systemic

 Findings on old photographs

Vision

With glasses

Without glasses

Glasses No.

Near vision with + 3.0 for amblyopes

 

Distance

Near

Distance

Near

  

RE

      

LE

      

Using glasses since

Present glasses since

Retinoscopy

  (Atropine/Cyclopentolate/Tropicamide/without cycloplegia)

        Deviation under cycloplegia

Fundus

Fixation

Any other ocular finding

Motor Assessment

  1. 1.

    Anomalous head posture (AHP): (a) Face (b) Chin (c) Head

  2. 2.

    Primary Ocular Direction: With glasses without glasses

  3. 3.

    Ocular Deviation (by Hirschberg Corneal Reflex) FLE   FRE 

  4. 4.

    Cover test

    1. (a)

      Nature of Deviation

      • Orthotropia

      • Phoria X or E

      • Tropia X(T), X(T)’, XT, XT’

        • E(T), E(T)’, ET, ET’

        • Preferential Fixation RE/LE/Either Eye

    2. (b)

      Amount of Deviation (confirmed with PCT)

      • FRE

      • FLE

      • Change without glasses

      • Change from up to downgaze

      • Near/distance disparity

      • AC/A ratio

  5. 5.

    Ocular movements

    (a) Versions (b) Limitation in ductions

  1. 6.

    Proximal convergence (a) Objective (b) Subjective

Sensory Assessment

  1. 1.

    Synoptophore

  1. (a)

    Simultaneous Macular Perception Yes/No

  2. (b)

    Fusion obtained at: (+):    maintained till: recovery at: (−):

  3. (c)

    Stereopsis Yes/No

  4. (d)

    .

Angle

Subjective

Objective (by corneal reflex)*

FLE

  

FRE

  

*Actually a part of motor assessment

  1. 2.

    Worth Four Dot Test

  2. 3.

    Randot Stereoacuity (a) Near (b) Distance

  3. 4.

    Diplopia Chart

    1. (a)

      .

  1. (b)

    Quadrant of maximum diplopia

  1. 5.

    Hess Chart

Diagnosis/Differentials

Special scores/tests for management planning & prognosis

  1. 1.

    Binocular Potential Score

  2. 2.

    Newcastle Control Score or Mayo Clinic Score for X(T)

  3. 3.

    Prism Adaptation Test (a) Deviation(b) Binocularity

  4. 4.

    Axial Length RE LE

Management Plan

Follow-up

(Abbreviations: FLE fixating with left eye, FRE fixating with right eye, X exophoria, E esophoria, X(T) intermittent exotropia, X(T)’ intermittent exotropia for near, XT exotropia, XT’ exotropia for near, E(T) intermittent esotropia, E(T)’ intermittent esotropia for near, ET esotropia, ET’ esotropia for near, PCT prism and cover test, AC/A Accommodative convergence/Accommodation, DV dextroversion, LV levoversion)

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Agrawal, S., Yadav, A., Singh, N. (2019). Clinical Evaluation of Strabismus. In: Agrawal, S. (eds) Strabismus. Springer, Singapore. https://doi.org/10.1007/978-981-13-1126-0_2

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  • DOI: https://doi.org/10.1007/978-981-13-1126-0_2

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-13-1125-3

  • Online ISBN: 978-981-13-1126-0

  • eBook Packages: MedicineMedicine (R0)

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