2025 – PAGE 251 – OPHTHALMOLOGY

EXOTROPIA

Exotropia is an outward deviation of the eye and. may be uni- or bilateral. In infants, it is common (unilateral or bilateral) up until the age of 3 months. If the right eye is staring at you and has a centered red light reflex while the left eye is deviated outward, the left eye has the exotropia and is likely to have a light reflex that seems medially displaced in comparison to the center of the pupil. The left eye is at risk for developing amblyopia. Treat by applying a patch to the “strong” right eye.

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NYSTAGMUS

Nystagmus is an abnormal finding regardless of age.

COLOR VISION

Color vision develops at 3 months of age. Binocular vision with convergence develops at 3 months of age. At 4 months, babies prefer to look at patterns and faces.

CORNEAL LIGHT REFLEX TEST

The corneal light reflex test is the one you do with your flashlight to look for strabismus, esotropia, exotropia, pseudostrabismus, etc. With normal alignment, the reflection should be symmetrical and located at the center of the pupils.

NOTE: In case you’re confused about the name, the “blink test” with a cotton swab to the eye has a similar name (Corneal Reflex Test).

COVER TEST

In a cooperative patient, the cover test is a more accurate test for strabismus than the corneal light reflex test. The patient should focus on an object, and each eye in turn is covered by an occluder while the uncovered eye is observed for movement. Normally, neither eye should move. In strabismus, the misaligned eye will move to refix on the object when the other eye is covered.