A 7-month-old girl is brought to the clinic for a well-child check up. Her birth and antenatal histories are unremarkable. Her developmental milestones are appropriate and all her vital signs are stable. On physical examination, a head tilt is noted. Ophthalmoscopic examination reveals a red reflex and normal corneal light reflex. The cover test reveals moderate esodeviation of the left eye. What is the most appropriate next step in the management of this patient?
A) Continuous covering of the deviated eye
B) Prompt surgical correction
C) Continuous covering of the normal eye
D) Measurement of intraocular pressure
E) Watchful waiting
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[sociallocker]This child has an esodeviation (i.e. medial deviation of the eye), which is the most common type of strabismus, representing over 50% of all cases. Strabismus is the most common cause of amblyopia, which is a decrease in the visual acuity of one or both eyes. The normal eye assumes the function of being the “preferred eye”, leading to amblyopia and eventual loss of vision in the deviated eye. Amblyopia occurs only during the first decade of life, a period during which the visual cortex is still maturing. During this stage, any anomaly (e.g. strabismus, abnormalities of refraction, or a media opacity within the visual axis) compromising the formation of a normal image on the retina may result in vision loss; therefore, the prompt diagnosis and management of such condition are essential. [/sociallocker]