Snapshot A 4-month-old boy is brought to the pediatrician by his parents after noticing he had a "lazy" eye. Birth history is unremarkable and there is no family history of such ocular findings. On physical exam, the corneal light reflex is notable for mild deflection of the light on the right eye. On cover testing there is refixation of the uncovered eye. The patient is subsequently referred to a pediatric ophthalmologist for specialized care. (Strabismus) Strabismus Clinical definition describes congenital or acquired misalignment of the eyes that can be horizontal vertical torsional Epidemiology incidence 2-4% of the population risk factors family history low birth weight vision deprivation login to view 1 more bullet Presentation physical exam eye misalignment can see login to view 3 more bullets Differential pseudostrabismus Studies this is a clinical diagnosis based on a number of physical exam maneuvers such as corneal light reflex cover test cover and uncover test Bruckner test testing is based on clinical suspicion for underlying etiology e.g., ordering neuroimaging for children with neurologic disorders Treatment treatment is dependent on underlying cause e.g., strabismus caused by refractive error can be treated with login to view 2 more bullets Complications amblyopia diplopia psychosocial and vocational impairment Amblyopia Clinical definition reduced visual acuity due to abnormal visual development in infancy or childhood login to view 1 more bullet Epidemiology incidence 1-5% worldwide risk factors strabismus refractive error vision deprivation login to view 1 more bullet prognosis most patients can be successfuly treated if detected early Presentation symptoms visual deficit physical exam strabismus login to view 1 more bullet Differential retinoblastoma Studies a clinical diagnosis Treatment correct underlying cause strabismus login to view 1 more bullet refractive error login to view 1 more bullet visual deprivation login to view 2 more bullets patching or optic penalization patching login to view 1 more bullet optic penalization login to view 1 more bullet both are equally effective Complications permanent vision loss of the affected eye