Clinical features:

Any child presenting with strabismus should have the following conditions ruled out:

Ø  Refractive error - refraction should be done under full cycloplegia i.e. Atropine Ointment 1% 3 times a day for 3 days prior to performing retinoscopy. If any refractive error is present, that should be fully corrected by spectacles for at least 3-6 months, before performing definitive surgical therapy for strabismus.

Ø  Any opacity in the media e.g. cataract, corneal opacity, retinoblastoma etc.

Ø  Amblyopia element whether induced by strabismus or vice versa should be treated with occlusion therapy or other modality before treating strabismus.

Surgical treatment:

1.       Correct the refractive error or associated cataract, corneal opacity etc.

2.       Fusion exercises for intermittent exotropia and other orthoptic exercises.

3.       Definitive therapy is surgical realignment of axis once other associated features have been treated.

Patient education:

u  Functional improvement in strabismus is best between 3-5 years of age. It is a misconception that squint is spontaneously corrected as the child grows.