🎧FREE MSRA PODCAST –Squint (Strabismus): Spot It, Treat It, Save Sight 👁️

Welcome to the Deep Dive. Today we’re decoding Squint (aka Strabismus) — a vital paediatricand ophthalmology topic that regularly shows up in the MSRA exam. From tropiasto phorias, and from patching to surgery, this is your go-to high-yieldsummary.

🧠What You'll Learn inThis Episode:

✅Definition

• Squint (strabismus) = misalignment of the eyes

• One eye focusesnormally, the other may turn inwards, outwards,upwards or downwards

• Mnemonic: "Tropia = True (Visible), Phoria = Phantom(Hidden)"

📚Classification Recap

🔹Manifest (Tropia) – seen when both eyes are open

🔹Latent (Phoria) – only appears when fusion is broken (cover test)

🔹Concomitant – deviation angle is the same in all directions

🔹Paralytic(Incomitant) – deviation varies withgaze

🧭 Directional Mnemonics:

• ESO = Eyes turn inwards(accommodative squint)

• EXO = Eyes turn outwards(convergence insufficiency)

• HYPER = One eye turns up, HYPO = One eye turns down

🔎Causes & RiskFactors

🔹Idiopathic – most common

🔹Neurological – e.g. cerebral palsy

🔹Muscle imbalance – congenital or acquired

🔹Geneticpredisposition – 30% have a familyhistory

🔹Prematurity

🔹Other eye diseases – e.g. childhood cataracts, ROP

🔬PathophysiologySummary

• Imbalance of the extraocular muscles or their neurological control

• In adults: mayfollow stroke, trauma, or thyroid eye disease

• In children: oftendevelopmental

🩺DifferentialDiagnosis (Don’t Miss)

• Pseudostrabismus – looks like a squint but it’snot (e.g. broad nasal bridge)

• Convergence insufficiency

• Paralytic nerve palsy (CN III, IV, VI)

📊Epidemiology

• 2–5% prevalence inthe UK

• Diagnosed by age 6in most cases

• Infantile misalignment often resolves in firstfew months

• Esotropia common in Caucasian children

• Exotropia more common in non-White populations

👁️Clinical Features

• Visiblemisalignment

• Diplopia(especially adults)

• Asthenopia (eyestrain, headaches)

• Head tilt orabnormal posture

• Clumsiness or poordepth perception

• Intermittentlyclosing one eye in bright light (often exotropia)

🧪Investigations

🔸Visual acuity (both eyes separately)

🔸Cover tests (standard, uncover, alternate)

🔸Corneal light reflex(Hirschberg’s test)

🔸Ophthalmoscopy

🔸Refraction

🔸Orthoptic assessment – definitive evaluation

💊Management (Mnemonic: "GAPS")

Glasses – correct refractive error

Amblyopia treatment – patching or atropinedrops

Prisms – help with diplopia in some cases

Surgery – for persistent or severe cases

🔹Early treatment is essential to prevent amblyopia

🔹 Botulinum toxin or miotic drops sometimes trialled

🔹 Orthoptic exercises help in convergenceinsufficiency

📉Prognosis &Complications

✔️ Good with early diagnosis and treatment

❌ Untreated = amblyopia, loss of depth perception

⚠️ Surgical risks: under/overcorrection, recurrence

😔 Psychosocial impact (bullying, self-esteem, jobinterviews)

📎More MSRA Resourcesfor Squint

📝 Revision Notes:

https://www.passthemsra.com/topic/squint-strabismus-revision-notes/

🧠 Flashcards:

https://www.passthemsra.com/topic/squint-strabismus-flashcards/

📖 Accordion Q&A Notes:

https://www.passthemsra.com/topic/squint-strabismus-accordion-qa-notes/

🎯 Rapid Quiz:

https://www.passthemsra.com/topic/squint-strabismus-rapid-quiz/

🧪 Quiz:

https://www.passthemsra.com/quizzes/squint/

🎓 More free revision content:

🌐https://www.passthemsra.com

🎁https://www.freemsra.com

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