Board Certified Ophthalmologist Pediatric Ophthalmology and Strabismus Questions and Answers

Question 1

A 4-month-old infant presents with a constant, large-angle esotropia of 50 prism diopters that has been present since birth.
Cycloplegic refraction reveals +2.00 D sphere in both eyes.
The fundus exam is normal.
What is the most appropriate next step in management?

Accepted Answer

Proceed with bilateral medial rectus muscle recessions.

Answer

Prescribe full cycloplegic correction and re-evaluate in 6-8 weeks.

Answer

Begin alternate-day patching of the dominant eye to treat presumed amblyopia.

Answer

Observe the patient for spontaneous resolution until 6 months of age.

Question 2

Which of the following is the primary mechanism by which atropine penalization treats amblyopia?

Accepted Answer

It blurs near vision in the sound eye by paralyzing accommodation, forcing the use of the amblyopic eye.

Answer

It paralyzes the extraocular muscles of the sound eye, preventing fixation.

Answer

It causes a miotic pupil in the sound eye, degrading the retinal image through diffraction.

Answer

It stimulates accommodation in the amblyopic eye, improving its focusing ability.

Question 3

A 6-year-old child presents with a complaint of an abnormal head posture, specifically a chin-up position. On examination, there is a marked limitation of elevation of the left eye when it is in the adducted position (looking up and to the right). Elevation in abduction is normal. What is the most likely diagnosis?

Accepted Answer

Brown syndrome

Answer

Inferior oblique palsy

Answer

Superior rectus palsy

Answer

Duane retraction syndrome Type 2

Question 4

A 5-year-old child undergoes vision screening and is found to have visual acuity of 20/80 in the right eye and 20/20 in the left eye. The child has no manifest strabismus. Cycloplegic refraction is +6.00 D sphere in the right eye and +1.50 D sphere in the left eye. What is the most likely cause of the decreased vision in the right eye?

Accepted Answer

Anisometropic amblyopia

Answer

Strabismic amblyopia

Answer

Deprivation amblyopia

Answer

Meridional amblyopia

Question 5

An A-pattern esotropia is characterized by a horizontal deviation that is:

Accepted Answer

Greater in upgaze than in downgaze.

Answer

Greater in downgaze than in upgaze.

Answer

Equal in upgaze and downgaze but greater than in primary position.

Answer

Associated with overaction of the inferior oblique muscles.

Question 6

A 4-year-old boy presents with an intermittent exotropia that is well-controlled, occurring less than 50% of waking hours, primarily at distance when he is tired. His visual acuity is 20/20 in each eye, and stereopsis is excellent when his eyes are aligned. Refractive error is plano. Which of the following is the most appropriate initial management strategy?

Accepted Answer

Observation with follow-up in 6 months to monitor for progression.

Answer

Immediate bilateral lateral rectus muscle recession.

Answer

Prescription of over-minus lenses to stimulate accommodative convergence.

Answer

Part-time occlusion of the dominant eye for 2-3 hours per day.

A 4-month-old infant presents with a constant, large-angle esotropia of 50 prism diopters that has been present since birth.Cycloplegic refraction reveals +2.00 D sphere in both eyes.The fundus exam is normal.What is the most appropriate next step in management?

A 4-month-old infant presents with a constant, large-angle esotropia of 50 prism diopters that has been present since birth.
Cycloplegic refraction reveals +2.00 D sphere in both eyes.
The fundus exam is normal.
What is the most appropriate next step in management?