In this episode, host Dr Maria Li is joined by Dr Parth Shah, an adult and paediatric ophthalmologist based in Canberra and Sydney, to discuss paediatric squints, also known as paediatric strabismus.

Beginning with an overview of why paediatric squints can seem daunting for general practitioners, and the importance of a systematic approach to assessment. Outlining GPs responsibilities when encountering a child with possible eye misalignment: diagnosing whether a true squint or pseudo-squint is present, assessing visual function, and determining the urgency of referral to a specialist.

Practical steps for eye examination in babies, particularly at the routine six-week check. Dr Parth Shah offers guidance on inspecting eye alignment, performing the corneal reflex test using a pen torch or ophthalmoscope, and checking the red reflex to rule out conditions such as congenital cataract.

As babies develop, the use of dynamic tests such as the cover test becomes more reliable, generally from three to six months of age, allowing for assessment of fixation and equal visual development between the eyes. GPs are advised to initiate urgent referral at any stage if there is concern about poor visual function, abnormal red reflex, or significant limitations in eye movement.

Further exploring referral processes, noting that detailed documentation of GP observations, supported by photos or videos from parents, greatly assists ophthalmology triage and assessment.

Links & Resources:

1. http://www.squintclinic.com/
2. https://www.schn.health.nsw.gov.au/eye-problems-children-factsheet
3. https://www.aapos.org/resource-catalog/educational-resources
4. https://medicinetoday.com.au/mt/2017/april/feature-article/assessing-eye-problems-children – GPs can access this article via a free online Medicine Today subscription.

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