Weinstock V M, Weinstock D J, Kraft S P
Faculty of Medicine, University of Toronto.
Can Fam Physician. 1998 Feb;44:337-43.
To review the clinical classification of strabismus, to describe the timing and method of strabismus screening examinations, and to discuss the principles of treatment.
Current literature (1983 to 1995) was searched via MEDLINE using the MeSH headings strabismus, ocular motility disorders, and amblyopia. Articles were selected based on their date of publication, clinical relevance, and availability. Preference was given to more recent articles, articles with large numbers of subjects, and well-designed cohort studies. Official recommendations from academic groups were analyzed. Descriptions of clinical tests and their illustrations are based on classic texts.
Primary care physicians should screen all low-risk children. High-risk children (low birth weight, family history of strabismus, congenital ocular abnormality, or systemic conditions with vision-threatening ocular manifestations) should be referred to an ophthalmologist for screening. Screening should be performed in the neonatal period, at 6 months, and at 3 years (Grade A recommendation), as well as at 5 to 6 years (Grade B recommendation). Screening examination includes inspection, examining visual acuity, determining pupillary reactions, checking ocular alignment, testing eye movements, and ophthalmoscopy.
Primary care physicians are essential to early detection of strabismus and amblyopia. Early detection can help minimize visual dysfunction, allow for normal development of binocular vision and depth perception, and prevent psychosocial dysfunction.
回顾斜视的临床分类，描述斜视筛查检查的时机和方法，并探讨治疗原则。
通过MEDLINE检索1983年至1995年的相关文献，使用医学主题词“斜视”“眼球运动障碍”和“弱视”。根据发表日期、临床相关性和可得性选择文章。优先选择较新的文章、受试者数量较多的文章以及设计良好的队列研究。分析学术团体的官方建议。临床检查的描述及其插图基于经典文献。
基层医疗医生应对所有低风险儿童进行筛查。高风险儿童（低出生体重、有斜视家族史、先天性眼部异常或有威胁视力的眼部表现的全身性疾病）应转诊至眼科医生处进行筛查。筛查应在新生儿期、6个月时、3岁时（A级推荐）以及5至6岁时（B级推荐）进行。筛查检查包括视诊、检查视力、确定瞳孔反应、检查眼位、测试眼球运动以及眼底检查。
基层医疗医生对于早期发现斜视和弱视至关重要。早期发现有助于将视觉功能障碍降至最低，使双眼视觉和深度感知正常发育，并预防心理社会功能障碍。
