Screening for childhood strabismus by primary care physicians.
OBJECTIVE
To review the clinical classification of strabismus, to describe the timing and method of strabismus screening examinations, and to discuss the principles of treatment.


METHODS
Current literature (1983 to 1995) was searched via MEDLINE using the MeSH headings strabismus, ocular motility disorders, and amblyopia. Articles were selected based on their date of publication, clinical relevance, and availability. Preference was given to more recent articles, articles with large numbers of subjects, and well-designed cohort studies. Official recommendations from academic groups were analyzed. Descriptions of clinical tests and their illustrations are based on classic texts.


RESULTS
Primary care physicians should screen all low-risk children. High-risk children (low birth weight, family history of strabismus, congenital ocular abnormality, or systemic conditions with vision-threatening ocular manifestations) should be referred to an ophthalmologist for screening. Screening should be performed in the neonatal period, at 6 months, and at 3 years (Grade A recommendation), as well as at 5 to 6 years (Grade B recommendation). Screening examination includes inspection, examining visual acuity, determining pupillary reactions, checking ocular alignment, testing eye movements, and ophthalmoscopy.


CONCLUSIONS
Primary care physicians are essential to early detection of strabismus and amblyopia. Early detection can help minimize visual dysfunction, allow for normal development of binocular vision and depth perception, and prevent psychosocial dysfunction.
Weinstock
V M
VM
Faculty of Medicine, University of Toronto.
Weinstock
D J
DJ
Kraft
S P
SP
D000367:Age Factors; D000550:Amblyopia / Q000517:prevention & control; D001724:Birth Weight; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D015331:Cohort Studies; D003867:Depth Perception; D005123:Eye / Q000033:anatomy & histology; D005124:Eye Abnormalities / Q000150:complications; D005133:Eye Movements; D005194:Family Practice; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008403:Mass Screening; D015835:Ocular Motility Disorders / Q000517:prevention & control; D009885:Ophthalmology; D009887:Ophthalmoscopy; D017410:Practice Guidelines as Topic; D011680:Pupil / Q000502:physiology; D012017:Referral and Consultation; D012025:Reflex, Pupillary / Q000502:physiology; D012307:Risk Factors; D013285:Strabismus / Q000145:classification / Q000235:genetics / Q000517:prevention & control* / Q000628:therapy; D014786:Vision Disorders / Q000517:prevention & control; D015348:Vision, Binocular; D014785:Vision, Ocular; D014792:Visual Acuity