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management strategi for strabismus

f . Mechanical Esotropia and Exotropia

The patient with mechanical esotropia or exotropia may need no specifictherapy if there is either minimal or no strabismus in the primary position

of gaze and the patient does not experience diplopia. For example,

treatment for Duane syndrome, which may have secondary tightness ofthe medial and/or lateral rectus muscle, is generally restricted to cases inwhich there is an objectionable compensatory head turn, a large anglestrabismus in the primary position, extreme elevation or depression of

the eye, or extreme retraction of the globe in adduction.92,93 Becausehead-turning is prevalent, amblyopia is uncommon and high-levelstereopsis usually exists. Prisms may be prescribed for slight head turns.For large head turns, surgery may be used, but it does not improve thedeficient abduction or adduction.

4. Patient Education

The prognosis, advantages, and disadvantages of the various modes of

treatment or management should be discussed with the patient and/or thepatient's parents, and a plan based on this dialogue should be developed.

Patients who suddenly develop strabismus of undetermined etiologyshould be informed that such an event may be related to a systemic orneurologic disease that would necessitate referral for consultation with,or treatment or management by, another health care provider.It is important for parents of strabismic children to learn about the

condition and the child's risks of developing amblyopia and impairedbinocular depth perception. Treatment and management plansformulated in consultation with the patient and parents should beresponsive to their preferences. The optometrist should elicit the child'sand/or the parents' expectations for outcomes, advise the persons

involved, relate the findings, prepare treatment and management plans,

discuss options, and recommend strategies for successful treatment and

management. Parents and children must understand that timelyexamination and management are critical to reducing the risk for loss ofvision and fusion and the development of other symptoms associated

with strabismus.

5. Prognosis and Follow-up

The purpose of the follow-up evaluation is to assess the patient'sresponse to therapy and to adjust treatment as needed (see Appendix

Figure 2). The schedule of follow-up visits depends upon the patient'scondition and associated circumstances. Follow-up evaluation includes

monitoring of several aspects of the patient's condition:Patient history

Visual acuity

Characteristics of strabismus at distance and near

Fusion status

Extraocular muscle function

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Refractive errorTolerance, efficacy, and side effects of therapy.