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Most children with strabismus do not experience diplopia. This symptom warrants
referral to an ophthalmologist. If the examination suggests
a cranial nerve palsy, or if other neurological symptoms are present, the
child should be seen promptly.
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What Shouldn’t
Be Missed
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Acute cranial nerve palsies may be due to idiopathic intracranial
hypertension or other intracranial diseases. Prompt evaluation and
treatment may improve the prognosis for both vision and the underlying
disorder.
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- 1. Physiological diplopia. This
is a normal phenomenon that is most commonly noted by bright and
observant children around ages 5 to 6 years. The eyes normally focus
on objects in a single plane, and these are seen as single images.
Objects in front of or behind the object of attention appear to
be double, but most people do not notice this. The diplopia can
be demonstrated by holding one finger up at arm’s distance
in front of your face, with another object (e.g., something on the
wall) in the background in line with your finger. If you focus on
your finger but pay attention to the object in the background, the
background object will appear double. Conversely, if you focus on
the background object but pay attention to your finger, the finger
will appear double (Figure 11–1). Most of the time these
double images are ignored, but children may become aware of them
and report them to their parents.
- 2. Breakdown of a phoria. Many
normal individuals have a phoria. A phoria is a tendency for the
eyes to become misaligned when one eye is ...