Board Certified Ophthalmologist FREE Board Certified Ophthalmologist Pediatric Ophthalmology and Strabismus Questions and Answers 2 — Questions and Answers
Question 1: A 4-year-old presents with an alternating exotropia that increases at distance fixation. What is the most likely diagnosis?
- Intermittent exotropia (Correct answer)
- Duane syndrome
- Convergence insufficiency
- Sensory exotropia
Correct answer: Intermittent exotropia
Intermittent exotropia characteristically worsens at distance and often presents with alternation in young children.
Question 2: Which test is most useful for detecting suppression in a child with strabismus?
- Worth 4-dot test (Correct answer)
- Cover-uncover test
- Hirschberg test
- Bruckner test
Correct answer: Worth 4-dot test
The Worth 4-dot test evaluates fusional status and readily identifies suppression by the absence of dots seen by one eye.
Question 3: A 6-month-old has a constant large-angle esotropia with cross-fixation. What is the recommended initial management?
- Bilateral medial rectus recession (Correct answer)
- Full-time occlusion therapy
- Observation until age 2
- Prism adaptation followed by surgery
Correct answer: Bilateral medial rectus recession
Infantile esotropia with large constant angles is best treated with early bilateral medial rectus recession to achieve alignment before cortical maturation.
Question 4: A child with retinoblastoma develops secondary esotropia in the affected eye. What is the underlying mechanism?
- Sensory deprivation disrupting fusion (Correct answer)
- Direct infiltration of the medial rectus
- Cranial nerve III palsy from tumor extension
- Increased intraocular pressure restricting motility
Correct answer: Sensory deprivation disrupting fusion
Loss of central vision from retinoblastoma causes sensory deprivation strabismus, most commonly esotropia.
Question 5: Which finding on cycloplegic refraction most strongly suggests accommodative esotropia in a 3-year-old?
- Hyperopia of +4.00 D or greater (Correct answer)
- Myopia of -3.00 D
- Astigmatism greater than 2.00 D
- Emmetropia with normal AC/A ratio
Correct answer: Hyperopia of +4.00 D or greater
Significant hyperopia drives excessive accommodative convergence, which is the hallmark mechanism of accommodative esotropia.
Question 6: A 7-year-old with Down syndrome presents with esotropia. Which additional ocular finding is most commonly associated?
- High accommodative convergence/accommodation ratio (Correct answer)
- Brushfield spots
- Persistent fetal vasculature
- Aniridia
Correct answer: High accommodative convergence/accommodation ratio
Children with Down syndrome frequently have a high AC/A ratio contributing to their esotropia, in addition to other common findings like Brushfield spots.
Board Certified Ophthalmologist FREE Board Certified Ophthalmologist Pediatric Ophthalmology and Strabismus Questions and Answers 2
A 4-year-old presents with an alternating exotropia that increases at distance fixation.
What is the most likely diagnosis?