Strabismus Management in the Child with Cerebral Palsy

Abstract

Examining children presents unique challenges to ophthalmologists. Examining a child with cerebral palsy (CP) presents even more difficulties due to multiple medical issues, developmental delays or even permanent lack of verbal communication, and cooperation issues. This, however, does not eliminate the need for a thorough ophthalmic examination and potential for intervention with either medical or surgical management for a multitude of ocular complications seen in patients with cerebral palsy.

Children with CP have a higher incidence of strabismus than the general population. Esotropia or crossing of an eye is the most common type of strabismus in children with CP. Treatment for strabismus includes medical management, such as glasses, occlusion or penalization therapy, and surgical management. While surgery for strabismus in children with CP carries an increased risk of under- or overcorrection compared to the same surgery in typically developing children, it has still been shown to be beneficial in decreasing amblyopia and improving binocularity. Proposed mechanisms to deal with this issue include adjustment of standard surgical nomograms or the use of botulinum toxin to the extraocular muscle, which typically has a temporary effect. At this time, there is no consensus as to how to adjust surgical treatment for the child with CP. Successful alignment may require multiple surgeries.