Board Certified Ophthalmologist FREE Board Certified Ophthalmologist Pediatric Ophthalmology and Strabismus Questions and Answers 2

Question 1

A 4-year-old presents with an alternating exotropia that increases at distance fixation. What is the most likely diagnosis?

Accepted Answer

Intermittent exotropia

Answer

Intermittent exotropia characteristically worsens at distance and often presents with alternation in young children.

Question 2

Which test is most useful for detecting suppression in a child with strabismus?

Accepted Answer

Worth 4-dot test

Answer

The Worth 4-dot test evaluates fusional status and readily identifies suppression by the absence of dots seen by one eye.

Question 3

A 6-month-old has a constant large-angle esotropia with cross-fixation. What is the recommended initial management?

Accepted Answer

Bilateral medial rectus recession

Answer

Infantile esotropia with large constant angles is best treated with early bilateral medial rectus recession to achieve alignment before cortical maturation.

Question 4

A child with retinoblastoma develops secondary esotropia in the affected eye. What is the underlying mechanism?

Accepted Answer

Sensory deprivation disrupting fusion

Answer

Loss of central vision from retinoblastoma causes sensory deprivation strabismus, most commonly esotropia.

Question 5

Which finding on cycloplegic refraction most strongly suggests accommodative esotropia in a 3-year-old?

Accepted Answer

Hyperopia of +4.00 D or greater

Answer

Significant hyperopia drives excessive accommodative convergence, which is the hallmark mechanism of accommodative esotropia.

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Board Certified Ophthalmologist FREE Board Certified Ophthalmologist Pediatric Ophthalmology and Strabismus Questions and Answers 2