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Ophthalmology for the Oncologist





Causes include:

Comitant strabismus

  • decompensation of pre-existing latent strabismus
  • full ocular movements
  • esotropia (convergent) > exotropia (divergent) strabismus

3rd Nerve palsy

  • ptosis >2mm
  • exotropia (divergent) and hypotropia (down) typically
  • limitation of elevation / depression / adduction
  • pupil dilated and poorly reactive or pupil sparing

 4th Nerve palsy

  • limitation of depression of eye in adduction
  • ipsilateral hypertropia (elevation of eye)
  • worse in contralateral gaze and ipsilateral head tilt
  • older child will complain of tilt of second image

6th Nerve palsy

  • limitation of abduction (unable to bury the limbus in the outer canthus)
  • esotropia (convergent strabismus) greater when fixing on distant targets
  • subjective horizontal diplopia especially when looking at distant targets

Supranuclear gaze palsy

  • gaze palsy (e.g. vertical gaze palsy and convergence retraction nystagmus associated with pinealoma – Parinaud’s syndrome).

Orbital infiltration (e.g. leukemia/lymphoma/metastases/rhabdomyosarcoma)

  • restricted eye movements
  • proptosis
  • +/- pain

Intraocular cause (e.g. Retinoblastoma / Intraocular lymphoma / leukaemia)

  • Poor red reflex
  • Poor vision (poor take up of fixation with the deviating eye)


Clinical Tip :


Cover test

While presenting a near / distant target, cover one eye at a time and then uncover.


Movement of the other eye to take up fixation will alert you to manifest strabismus (unless poor vision / limitation of eye movement)





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