Strabismus

Strabismus requires regular follow-up because it interferes with binocular vision, can cause amblyopia in children, and may recur after treatment. The follow-up schedule depends on the patient’s age, visual acuity, type of strabismus and control of the deviation in intermittent strabismus.[2]Sprunger DT, Lambert SR, Hercinovic A, et al. Esotropia and exotropia preferred practice pattern®. Ophthalmology. 2023 Mar;130(3):P179-221. https://www.doi.org/10.1016/j.ophtha.2022.11.002 http://www.ncbi.nlm.nih.gov/pubmed/36526451?tool=bestpractice.com ​​​​

Children are at particularly high risk of poor outcomes following the restoration of eye alignment and should be followed up until visual maturity is reached. The younger the child, the more frequently these examinations should take place.[2]Sprunger DT, Lambert SR, Hercinovic A, et al. Esotropia and exotropia preferred practice pattern®. Ophthalmology. 2023 Mar;130(3):P179-221. https://www.doi.org/10.1016/j.ophtha.2022.11.002 http://www.ncbi.nlm.nih.gov/pubmed/36526451?tool=bestpractice.com Children without amblyopia may be seen every 4-6 months, with this frequency reduced further by age 7-10 years. By contrast, new or changing findings may indicate need for more frequent follow-up examinations. In the child with recurrent esotropia after successful initial treatment, check for uncorrected or undercorrected hyperopia. Also, it is recommended to repeat cycloplegic refraction before concluding that the esotropia does not have an accommodative component. Follow-up should otherwise include assessments of the frequency of deviation, adherence to treatment, ocular motility, and refractive correction, as needed.[2]Sprunger DT, Lambert SR, Hercinovic A, et al. Esotropia and exotropia preferred practice pattern®. Ophthalmology. 2023 Mar;130(3):P179-221. https://www.doi.org/10.1016/j.ophtha.2022.11.002 http://www.ncbi.nlm.nih.gov/pubmed/36526451?tool=bestpractice.com

In patients treated with prisms (new-onset strabismus, smaller angle deviations, older children and adults), a control visit should be scheduled after several weeks to see how the patient is functioning. If the prisms are not adequate, consider changing the prism or treatment. In both adults and children where spectacles or other conservative treatments have been successful in aligning the eyes, the frequency of follow-up visits can be decreased.

After extraocular muscle surgery, the patient is seen within the first few days to evaluate ocular alignment and motility, to exclude early post-operative infection, and to exclude a slipped muscle (i.e., an unexpected deviation or motility defect).