Pediatric Ophthalmology & Strabismus

A type of esotropia common in childhood, where one or both eyes turn inward due to accommodative effort caused by hyperopia or a high AC/A ratio. Spectacle correction is the mainstay of treatment, and early intervention is important for achieving binocular vision.

A technique to readjust the position of extraocular muscles after strabismus surgery to reduce overcorrection or undercorrection. Several methods exist, such as the bow-tie technique and the sliding noose technique.

A condition in which abnormal visual input occurs during the sensitive period of visual development, resulting in insufficient development of corrected visual acuity. It is classified into four types: refractive error, anisometropia, strabismus, and form deprivation. It is found in approximately 1-5% of children, and early detection and early treatment affect the visual prognosis.

Treatment of strabismus by injection of botulinum toxin type A into extraocular muscles. Approved in 2015 (Botox®), with insurance coverage for strabismus in patients aged 12 years and older. This article details the physician qualifications and administration protocols based on guidelines from the Japanese Association of Strabismus and Amblyopia and the Japanese Neuro-ophthalmology Society.

A vertical strabismus characterized by limitation of elevation in adduction due to an abnormality of the superior oblique tendon-trochlea complex. It is classified into congenital and acquired types. Spontaneous resolution is common, but surgery is indicated when hypotropia or abnormal head posture is severe.

A congenital eye disease in which tissue defects occur in various parts of the eye due to incomplete closure of the embryonic fissure. It is often accompanied by microphthalmia and causes visual impairment and complications depending on the location of the defect.

This article explains the incidence, diagnosis, and treatment of intraoperative and postoperative complications in strabismus surgery. It covers prevention and management of complications from scleral perforation, oculocardiac reflex, lost muscle to anterior segment ischemia and postoperative infection.

Lens opacity that develops at birth or during infancy, causing form deprivation amblyopia. The timing of surgery, appropriateness of IOL implantation, and postoperative amblyopia treatment determine visual prognosis.

Congenital nasolacrimal duct obstruction is a congenital blockage of the tear drainage system primarily caused by a membranous obstruction at the lower end of the nasolacrimal duct, occurring in 6–20% of newborns. About 90% resolve spontaneously by 12 months of age, but persistent cases are treated with conservative therapy such as lacrimal sac massage (Crigler method), probing, or lacrimal endoscopy surgery.

Dissociated vertical deviation (DVD) is an abnormal eye movement that does not follow Hering's law, in which the non-fixing eye slowly elevates. It is frequently associated with infantile esotropia, and treatment options include anterior transposition of the inferior oblique muscle and recession of the superior rectus muscle.

Esotropia is a misalignment of the eyes in which one eye deviates inward (toward the nose). The main types are infantile esotropia and accommodative esotropia. For infantile esotropia, very early surgery (≤8 months) is advantageous for achieving binocular vision, while for accommodative esotropia, full refractive correction with glasses is the basic treatment.

Exotropia is a misalignment of the eyes in which one eye deviates outward. Intermittent exotropia is the most common type. This article explains classification, diagnosis, and treatment including surgery.

A clinical test to record dysfunction or overaction of the extraocular muscles and evaluate incomitant strabismus. This article explains the Hess chart, which uses red-green goggles to diagrammatically record ocular deviation.

Hypertropia is a vertical strabismus in which one eye is deviated upward relative to the other. The most common cause is superior oblique muscle palsy, which can be congenital or acquired. Diagnosis involves the Parks three-step test and the Bielschowsky head tilt test. Treatment options include prism correction and strabismus surgery, depending on the cause.

A large-angle constant esotropia that develops within the first 6 months of life. Early surgical correction is important for achieving binocular vision.

Intermittent exotropia is a type of strabismus in which the eye alignment is normal most of the time but one eye drifts outward when tired or looking at distant objects. It is the most common type of strabismus in children. This article explains its classification, diagnosis, and treatment.

Moebius syndrome is a rare congenital disorder characterized by horizontal gaze palsy and facial paralysis due to congenital dysfunction of the sixth and seventh cranial nerves. It is classified under congenital cranial dysinnervation disorders (CCDDs).

An eye movement disorder in which one eye is limited in upward gaze in both adduction and abduction. It is often congenital and presents with hypotropia, ptosis, and abnormal head posture.

A congenital optic disc anomaly characterized by funnel-shaped excavation of the optic disc, white glial tissue, and radial blood vessels. It is frequently associated with retinal detachment and is known to be related to transsphenoidal encephalocele.

Childhood myopia is a refractive error that develops during school age, primarily caused by axial elongation. Multiple progression control therapies, including low-dose atropine eye drops, myopia management spectacles, multifocal contact lenses, and orthokeratology, have accumulated evidence.

A comprehensive explanation of the definition, classification, diagnosis, and treatment of congenital nystagmus (jerky nystagmus, pendular nystagmus), nystagmus blockage syndrome, latent nystagmus, spasmus nutans, and periodic alternating nystagmus. Includes indications for refractive correction, prism therapy, and surgical procedures such as the Kestenbaum procedure.

An infection of the soft tissues within the orbit posterior to the orbital septum. Most commonly spreads from sinusitis and frequently occurs in children. It presents with proptosis, ophthalmoplegia, and vision loss, requiring prompt antibiotic therapy and, if necessary, surgical drainage.

Pattern strabismus (A-V pattern strabismus) is a condition in which the horizontal deviation differs between upward and downward gaze. This article explains the classification into V, A, Y, X, and λ patterns, etiology, diagnosis, and surgical treatment.

Pediatric vision screening aimed at early detection of amblyopia, strabismus, and refractive errors. This article explains the selection of examination methods according to age and the screening system centered on Japan's 3-year-old health checkup.

Explains visual acuity testing methods for infants to preschool children by age. Introduces the characteristics and procedures of each test, such as preferential looking, Teller acuity cards, LEA symbols, and Landolt C rings.

Photoscreening is a vision screening method that uses a camera to capture and analyze the red reflex in children, detecting refractive errors and strabismus that are risk factors for amblyopia.

A rare congenital glaucoma in which intraocular pressure rises due to impaired aqueous humor outflow caused by developmental abnormalities of the anterior chamber angle. Surgery is the first-line treatment, and early diagnosis and treatment determine visual prognosis.

A condition in which the eyes appear misaligned despite the absence of true deviation of the visual axes. It is most commonly pseudoesotropia due to facial morphological features such as epicanthal folds or an abnormal angle kappa.

A proliferative vascular disease affecting the immature retinal vessels of preterm infants. The lower the gestational age and birth weight, the more severe the disease tends to be, accounting for approximately 30% of childhood blindness. It is classified by zone, stage, and plus disease based on ICROP3, and laser photocoagulation or anti-VEGF therapy is performed for type 1 ROP according to ETROP criteria.

An objective refraction method that uses a retinoscope to measure refractive errors of the eye. It is essential for evaluating patients who cannot undergo subjective testing, such as infants and individuals with developmental delays.

This article provides an overview of strabismus surgery, including indications, surgical techniques (recession, resection, muscle transposition, adjustable sutures), timing, complications, and postoperative management. It covers everything from early surgery for infantile esotropia to surgical planning for adult strabismus.

The synoptophore (major amblyoscope) is an instrument that examines and trains binocular vision (simultaneous perception, fusion, stereopsis) using independent optical systems for the left and right eyes. It enables quantitative measurement of subjective strabismic angle in 9 directions, measurement of fusion range, and measurement of cyclodeviation. It is also used for vision training in children aged 3 years and older with strabismus or amblyopia.

Vertical strabismus is a general term for vertical misalignment of the eyes. Congenital superior oblique palsy is the most common cause, and also includes inferior oblique overaction, Brown syndrome, A-V pattern strabismus, and double elevator palsy. Diagnosis is made using the Parks 3-step test, and surgery such as inferior oblique weakening, superior oblique tuck, or Harada-Ito procedure is performed depending on the angle and type of strabismus.

The Worth 4-Light Test (W4LT) is a clinical examination that uses red-green glasses to evaluate binocular vision (fusion, suppression, anomalous retinal correspondence, diplopia). It can be performed from around 3 years of age and is tested at both near and far distances.

This article explains the purpose, methods, and flow of vision screening during the 3-year-old health checkup. It details the primary to tertiary examination process under the Maternal and Child Health Act, the introduction of photoscreeners, early detection and treatment of amblyopia, and coordination with preschool and school health checkups.