Referral guideline – Strabismus (squint)

Introduction

Strabismus, or ‘squint’, is a condition in which the eyes are not properly aligned with each other. One eye is either constantly or intermittently turned in (esotropia) or out (exotropia).

This ocular misalignment may be accompanied by abnormal motility of one or both eyes, double vision, decreased vision, ocular discomfort, headaches, or abnormal head posture.

Young children with strabismus often develop amblyopia (lazy eye) and impaired stereopsis (binocular depth perception). Early identification and treatment may prevent amblyopia.

Strabismus can be a presentation of retinoblastoma (check red reflex) or intracranial tumour (check abduction is full).

GP management

Please check the following:

  • visual acuity (VA) if possible (usually older than 3yrs) – if the child is too young to check VA, ascertain whether the child can fix and follow – try a toy or a light
  • cover test
  • ocular motility – ask child to look in the direction of gaze of the extraocular muscles (use a toy or a light for very young children)
  • fundus examination and note presence/absence of red and white reflex
  • pupillary reactions and sizes
  • note any behavioural issues (was the child hard to assess, do they have a history of ADHD or autism etc).

When to refer

Refer for non-urgent excision (category 3) when:

  • all children with Strabismus should be referred to an ophthalmologist
  • behavioural optometry is NOT indicated as there is no evidence base for this
  • acute onset of Strabismus requires IMMEDIATE REFERRAL.

Essential referral info

  • Presenting complaint and reason for referral
  • Date of onset (is it acute?) and frequency of the ocular misalignment
  • Is the deviation constant or intermittent?
  • Unilateral or alternating?
  • Patient details (name, age and gender)
  • Medicare number
  • Parent/Carer’s name and contact details
  • Referring clinician details (name, contact details, provider number, date and length of referral)
  • Parent/Carer’s name and contact details

From 1 May 2019 referral criteria will apply at CHQ. This condition has minimum demographic and essential clinical referral information that is required to be included prior to submission of the referral. Visit the CPC website for the required condition. If you are unable to provide the required “essential information” please state the reason when you submit the referral.

Helpful referral info

  • Ocular history, including other eye problems, injuries, diseases, surgery, treatments including glasses and/ or amblyopia therapy
  • Other past medical and surgical history
  • Antenatal and perinatal history that may be relevant – prematurity, birth weight, birth trauma, alcohol/drug use in pregnancy
  • Family history – of eye conditions or genetic conditions
  • Current medications and allergies
  • Examination findings – including any dysmorphic features, full ocular examination
  • Is the patient of Aboriginal or Torres Strait Islander descent?

Parent service

Ophthalmology

Contact details

Hospital Switchboard
(Ask for Ophthalmology On-call Registrar)
t: 07 3068 1111

Resources

Description of Red Reflex (Bruckner) test
Red Reflex video
List of CHQ aligned optometrists
Emergency Eye Manual