Pseudostrabismus and treatment of strabismus

Some facial dysmorphies may give rise to an external appearance of strabismus; but careful examination, by corneal reflex or cover test methods, shows that the eyes are perfectly aligned.

The most frequent causes of pseudostrabismus are epicanthus, which simulates convergent strabismus, and hypertelorismus, which simulates divergent strabismus.

Clinical forms of strabismus

Strabismus can be classified according to several criteria.

According to the direction of the deviation they can be convergent or endotropical, divergent or exotropic, vertical, oblique and torsional.

According to the variation of the deviation in the different versions, they can be concomitant or incomitant, whose most demonstrative type would be paralytic strabismus.

Depending on the constancy of the deviation, they are classified as constant or intermittent.

According to the deviated eye, it will be monocular if it is always the same, or alternating, if one eye or the other deviates indistinctly.

General guidelines for the treatment of strabismus

In order to obtain a good anatomical and functional result in the treatment of strabismus, early diagnosis is essential. If this premise is met, most cases are solved with optical correction, occlusion and surgery. Complex treatments based on endless sessions of pleoptic and orthoptic exercises have fallen into disuse.

Optical correction should be used constantly, and, in general, the child accepts it well as long as the family environment is not against it. Secured spectacles do not constitute any risk to the eye, even in the case of trauma, and rather act as a means of protection.

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Occlusion should be constant as long as there is deviation, although the rhythm between the two eyes will vary according to the degree of amblyopia and the age of the child.

Surgical treatment should be very early, before the age of two years in congenital endotropia. In acquired endotropia, it will be performed as soon as it is observed that glasses do not fully correct the deviation. It will be late in intermittent exotropia and early in constant exotropia. In all cases, amblyopia, if present, should be previously treated with occlusion. Usually, the hospitalization is only one day, and after three or four days, the child can perform his usual activities.