A current summary of strabismus in children

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Strabismus, defined as misalignment of the eyes, is a common ocular disorder in childhood that can result in impaired vision. Although in the title of the article, Dr Regnier uses the contemporary word strabismus, the author uses throughout the article the earlier term squint in reference to evaluating pediatric patients “whose eyes are not straight.” Referring to the Oxford English Dictionary, the word “squint” dates back to 1652. In the 1950s, it was generally used among the medical profession. Perhaps, because of its negative connotations in the lay community, it has currently lost favor. The author also uses the term “retrolental fibroplasias” in his review of strabismus in children. The current terminology is retinopathy of prematurity. Retrolental fibroplasia describes advanced cases of the disease entity in which the retina has become detached and has contracted behind the lens of the eye. Today, this advanced stage of the disease rarely occurs because of progress in prevention and treatment.

The author includes a cogent discussion of esotropia, exotropia, amblyopia, abnormal retinal correspondence, and fusion.

When discussing surgery, the author points out that two days of hospitalization is usually sufficient. Today, the vast majority of strabismus surgeries are performed on an outpatient basis. The author also states that operations on the ocular muscles is feasible at one year, because earlier the risk of anesthesia is too dangerous. With advances in anesthesia, strabismus surgery can be safely performed as early as three months of age.

The author lists numerous types of strabismus that cannot be successfully treated in 1953, including strabismus related to a marked difference in refractive error, commonly referred to as anisometropia. For example, if a child has essentially no refractive error in one eye and is markedly myopic in the other, the myopic eye is likely to become amblyopic. Currently, contact lenses are often used to treat this condition. Another potential treatment for this condition would be laser-assisted in situ keratomileusis (LASIK), a surgical procedure in which a flap is created in the cornea with a microkeratome and a laser is used to reshape the underlying corneal bed. Currently, most LASIK procedures are performed in adults to correct nearsightedness. Theoretically, LASIK should be highly effective in treating children with markedly different refractive errors. Although LASIK is not currently approved by the FDA, preliminary LASIK studies in children for this condition appear encouraging. In contrast to adults in which LASIK is performed with topical anesthetic drops, LASIK in children is usually performed with general anesthesia.