How to examine a strabismus patient?

History

Take good history including following points in consideration

 At what age deviation was first noticed?

Whether it is contestant or intermittent?

Which eye usually deviated?

Whether diplopia is present?

Family history

Inspection

Inspect for head tilt, chin up or down and face turn.

Inspect for fixation OD, OS or OU

Refraction

• Cyclopleagic refraction under atropine 1% for children below 6 years
• Cyclopleagic refraction under Homatropine 0.5 % or Cycopent 1 % for children above  6 years
• Subtract only working working distance from the retinoscopy for children below 6 years for prescription of glasses

 Orthoptic Examination

1. Head posture

·        Head turn

·        Face turn

·        Chin

 2. Ocular Movements

 3. Nystgmus

4. Inter papillary distance

5. Near point of convergence

6. Near point of accommodation

7. Prism Bar Cover Test (PBCT) with glasses in place

• Distance
• Near 
• In nine diagnostic positions

8. Subjective measurement of deviation for distance by Maddox Rod with Prism Bar Cover Test

9. Subjective measurement of deviation for near with Maddox Wing

10. State of Binocular Vision

• Baggolini Striated Glass Test
• Worth Four Dot Test
• After Image Test
• Randots Sterioacuity
• Synptophore

11. Fusional Amplitude

12. Sterereopsis

13. Diplopia Charting

14 Hess / Lee Charting

15. Force Duction Test

16 Force Generation Test

Download Patient Case Sheet Performa In Word Format

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