Urgent Referral to Pediatric Ophthalmology is Required
This 2-month-old infant with esotropia (inward eye deviation) requires urgent referral to a pediatric ophthalmologist, not reassurance or CT imaging. 1
Why Urgent Referral is Essential
Infants with esotropia appearing before 6 months of age should be referred to a pediatric ophthalmologist for comprehensive evaluation and management to preserve binocular vision. 1 The key concerns are:
- High risk for amblyopia development: Infantile esotropia carries significant risk for permanent visual impairment if not treated early 1
- Critical developmental window: The rapidly developing visual system in infants means delayed treatment may be disadvantageous for achieving binocular realignment 1
- Binocular vision preservation: Early intervention is necessary to prevent long-term loss of binocular vision 1
Why Reassurance is Inappropriate
While some intermittent eye misalignment during the first 3 months of life can be normal 1, this case warrants immediate action because:
- Age threshold exceeded: Ophthalmological evaluation becomes necessary if strabismus persists beyond 3-4 months of age or the deviation becomes constant 1
- At 2 months with constant esotropia during feeding, this infant is already showing concerning signs that require specialist evaluation 1
- Children with infantile esotropia remain at high risk for developing amblyopia and losing binocular vision, making early detection and treatment critical 1
Why CT is Not Indicated
- CT imaging is not part of initial management for infantile esotropia 1
- The initial management should involve a comprehensive ophthalmological examination, including cycloplegic refraction to assess for refractive errors, rather than CT imaging 1
- The intact red reflex and symmetrical cornea reflections suggest no structural abnormality requiring neuroimaging 1
What the Ophthalmologist Will Do
The specialist evaluation will include:
- Comprehensive ophthalmological examination with cycloplegic refraction to assess for refractive errors that may be contributing 1
- Assessment for high hyperopia: This can increase the risk of accommodative esotropia 2.7 to 18 times 2
- Treatment planning may include optical correction, observation with close monitoring, or surgical intervention depending on deviation magnitude 1
Common Pitfall to Avoid
Do not delay referral waiting to see if the esotropia resolves spontaneously. While some intermittent misalignment is normal in the first 3 months, constant esotropia at 2 months during feeding activities requires prompt specialist evaluation to prevent irreversible amblyopia 1, 3
Answer: B - Urgent referral for ophthalmology