Case history
Case history #1
A 4-month-old healthy girl with normal antenatal and birth history is brought in by her parents, who note that both her eyes are looking towards the nose. Examination shows a large-angle esotropia with freely alternating fixation (i.e., each eye fixates objects, with no preference for either eye). No significant refractive error is present, and the remainder of the eye examination is normal. The infant is diagnosed with infantile esotropia.
Case history #2
A 34-year-old man complains of double vision after recovering from facial trauma that included a fracture of the left orbital floor. He describes the double vision as manifesting with one image on top of the other. The patient complains that he is unable to function unless he closes one eye. Examination shows hypotropia of the left eye, which becomes larger when the patient tries to look up. The remainder of the ocular examination is normal. A CT scan of the orbits demonstrates orbital tissue herniating through a fracture in the floor of the left orbit, and the patient is diagnosed with restrictive incomitant left hypotropia.
Other presentations
If strabismus occurs acutely, and it does not meet the criteria for primary strabismus, the patient must be urgently referred to an ophthalmologist for a thorough evaluation. This may represent an intra-cranial process, such as a mass lesion, aneurysm, raised intra-cranial pressure, central nervous system (CNS) infarction, or inflammation in the CNS.
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