Diagnosis and Management of Double Vision in Children

Introduction to Double Vision

The American Academy of Family Physicians recommends that a 5-year-old child presenting with double vision requires immediate referral to a pediatric ophthalmologist or appropriately trained eye care specialist, as diplopia in this age group is uncommon and may indicate serious underlying pathology including strabismus, amblyopia risk factors, or neurologic disease 1

The American Academy of Family Physicians suggests that strabismus, which affects 5-10% of preschoolers, can be assessed by cover test and Hirschberg light reflex, and amblyopia and amblyogenic risk factors, present in 1-4% of preschool children, can be identified through comprehensive evaluation 1, 2

The American Academy of Ophthalmology recommends that the pediatric ophthalmologist perform a sensorimotor evaluation, including binocular alignment testing in multiple fields of gaze, stereoacuity testing, and Worth 4-Dot testing to assess fusion 2, 3, 4, 5
The American Academy of Ophthalmology suggests that cycloplegic refraction is essential in children to accurately determine refractive error, and typically uses cyclopentolate 0.2% with phenylephrine 1% in children under 6 months, or cyclopentolate 1% in older children 3, 4, 5

The American Academy of Family Physicians states that early intervention is critical because visual impairment from amblyopia, strabismus, and refractive error affects 5-10% of preschoolers and can harm school performance and future quality of life, and there is an early sensitive period when interventions lead to better outcomes 1, 2
The American Academy of Family Physicians recommends treatment options, determined by specialist, which may include glasses, contact lenses, or refractive correction for refractive errors, patching or atropine therapy for amblyopia, surgery for strabismus or cataracts, and visual training for specific conditions 1, 2