Strabismus - Fundamentals of Clinical Ophthalmology.pdf

THERAPY OF STRABISMUS
Figure 7.2 Black pirate patch. Can alternatively be
attached to glasses
Figure 7.1 Arm splints allow child to play but not
remove patch
long sighted and requires glasses to control the
squint but refuses to wear glasses, initial use of
mydriatic drops daily will make the vision
blurred without glasses. In this circumstance
acceptance of glasses is made easier.
Some young children enjoy wearing an eye
patch if they feel they’re playing a character like
a pirate (Figure 7.2). School-age children can be
unkind about difference, calling children with
glasses “four-eyes”, calling children with squint
“dumb”. We’ve even known children to refuse to
sit with children with visual problems. In
kindergarten children are more accepting, and
kindergarten teachers can do much to explain
and assist the child receiving treatment. From
age 6 onwards it becomes more difficult with
larger classes and students are more difficult to
control. In some cases children won’t wear
glasses, but more frequently they flatly refuse to
wear occlusion. In such cases it is our strongly
held belief that occlusion should be part time
and carried on out of school hours.
With this regime we have plenty of experience
of recovery of vision, including amongst children
brought for second opinion because of refusal to
accept occlusion during school hours. In young
and also older children, the near vision test charts
matching tests can be photocopied and parents
encouraged to check progress of the occlusion
tests at home. Even the letters in the phone book
can be used. Children wearing glasses often
object to occlusion if the occluder is stuck to the
face. This can be avoided by the use of paper
occluders attached to the glasses.
With adults, the eye health professional team
is smaller. The strabismus specialist treating the
adult may not need an assistant because the
adult should be more in control of their anxieties
and should be more cooperative. However,
unlike children, they may be demanding in a
different way, depending on their expectations.
They may seek cosmetic improvement, relief of
double vision or seek restoration of binocular
vision when this has been absent since
childhood. Recent onset of symptoms in
strabismus present since childhood are unlikely
to be related unless there is decompensation, for
example in a case of superior oblique paresis that
has previously been fusing.
Management of amblyopia in strabismus
Management of strabismic amblyopia is a
critical part of care of the strabismic infant or
child. Strabismic amblyopia has a critical period
more extended than in pattern deprivation
amblyopia, though less than that in refractive
amblyopia. It occurs during development when
there is plasticity of the brain. Simple occlusion
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