Strabismus

Template

Tap a choice or type a Repertoire Line to see how the note changes. Defaults are what the template inserts on its own.

Try a Repertoire Line

Practice wording only: leave out patient details. Nothing typed here is saved or sent.

DiagnosisChoose oneTitle

LateralityChoose oneFirst line

AssessmentChoose one

Warning findings presentChoose any

Warning findings absentChoose any

HistoryChoose any

PlanChoose one

Current treatmentChoose anyNot in the note with these choices

Follow-upChoose one

Follow-up reasonChoose anyJoins the line above

Counseling paragraphChoose oneParagraph

Note when inserted as is

Strabismus
• Eye misalignment confirmed on corneal light reflex and cover testing
• No sudden onset, double vision, headache or other neurologic symptoms, eyelid droop or unequal pupils, asymmetric red reflex, or nystagmus
• Referred to pediatric ophthalmology given strabismus beyond early infancy
• Follow up after the specialist visit

Strabismus does not go away on its own after early infancy, and the eye that turns can lose vision (amblyopia) if it is not treated. The eye doctor may use glasses, patching, or eye drops, and sometimes surgery, to straighten the eyes and protect vision. Return precautions given including eyes that cross or drift more often, sudden new crossing, double vision, headaches, an eyelid droop, a white reflection in the pupil or in photos, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Title variants: pseudostrabismus, esotropia, exotropia, intermittent strabismus of early infancy
Laterality: right, left, alternating
Misalignment confirmed on light reflex and cover test
Pseudostrabismus: symmetric light reflex, normal cover test, epicanthal folds
Intermittent misalignment under 4 months is often normal
Unable to distinguish strabismus from pseudostrabismus needs referral
Warning findings: sudden onset, double vision, neurologic symptoms, ptosis or anisocoria, asymmetric red reflex
Family history of strabismus or amblyopia; crossing in photos
Referred to ophthalmology
Continue lenses or patching per ophthalmology

Show 2 more

Follow-up after specialist, 4 month visit, next well check, as needed
Amblyopia risk, treatment options, pseudostrabismus course

Return precautions in the template

eyes that cross or drift more oftensudden new crossingdouble visionheadachesan eyelid droopa white reflection in the pupil or in photos

Sources

Cribsiders #38 Ophthalmology in Pediatrics (Nov 10, 2021)
AAP Policy Statement, Visual System Assessment in Infants, Children, and Young Adults by Pediatricians. Donahue SP, Baker CN; COPAM, Section on Ophthalmology, AAPOS,…
AAP Clinical Report, Procedures for the Evaluation of the Visual System by Pediatricians. Donahue SP, Baker CN. Pediatrics 2016;137(1):e20153597. Reaffirmed February…
The Cribsiders #153: Retinoblastoma