Today, let’s discuss this pediatric patient who came into the office for their first eye exam in the states after immigrating from Turkey. A previous eye doctor had let him know he had an eye turn and was given glasses. Mom says that the glasses helped the eye turn, but then the glasses were lost sometime in the last month. The patient is otherwise healthy, has no allergies, and is not taking any medications.
Pupils, confrontation fields, EOMs, and color vision are all normal. He did not appreciate randot stereoacuity and he reported 5 lights on worth 4 light.
Distance cover test reveals about 27pd left esotropia, whlie at near, it’s measured as 16pd left esotropia; the patient was uncorrected for both emasurements.
Uncorrected visual acuity is OD 20/20, OS 20/20.
Dry retinoscopy and refraction show:
OD: +0.75 DS 20/20-
OS: +1.25 -0.50 x 175 20/20
At this point, what drops would you use to dilate this patient and why? Can you review the different properties and effects of Tropicamide vs Cyclopentolate vs Phenylephrine?
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We ended up using 1% Cyclopentolate for this patient and got the following results:
OD: +3.00 -0.50 x 180 20/20
OS: +3.75 – 0.50 x 170 20/20
All ocular health findings were normal.
What glasses prescription would you recommend for this patient? Given that the patient is 8 years old and able to see 20/20, what is your recommended follow up for this patient? If the patient were actually 5 years old, would any part of your management be different? And lastly, what are your thoughts around strabismus surgery in this case?
I’m looking forward to reading your thoughts.