Referral criteria from primary care - squint (strabismus)

• intermittent deviation of the eyes is a quite common finding in healthy neonates and should not cause undue concern
  • normal binocular coordination becomes evident at about three months and strabismus (squint) after this age is significant.
• constant squint is generally recognised early by the family, health visitor or general practitioner. A positive family history of squint or amblyopia should alert those in primary care when carrying out routine checks or immunisations
• strabismus is often found in association with neurological disease such as in cerebral palsy and in craniofacial developmental anomalies
• strabismus, amblyopia and refractive error are much more common in children with treated or regressed retinopathy of prematurity (ROP) Premature infants with a history of stage III ROP or worse should be followed up after the neonatal period to screen for these complications
• if squint or amblyopia is suspected in the primary care setting, it is appropriate for local protocols to provide for direct referral to an optometrist or an orthoptist to exclude refractive error and strabismus. If no abnormality is detected, such patients may be discharged
  • cases with intermittent or constant manifest squint should be referred to an ophthalmologist without delay. In all children referred with strabismus or amblyopia the possibility must be considered that this is the presenting feature of a serious ophthalmic or systemic disease requiring urgent management
  • NICE suggest that a 2 week referral is indicated if a new squint or change in visual acuity and cancer is suspected (Refer non-urgently if cancer is not suspected)

Reference:

• (1) RCOphth. Guidelines for the Management of Strabismus and Amblyopia in Childhood. 2000 (http://www.rcophth.ac.uk/docs/publications/ManagementSquint&Amblyopia2000.pdf)
• (2) NICE (June 2005). Referral Guidelines for Suspected Cancer