Examine the fundus with both direct and indirect ophthalmoscopes. Note the appearance of the macula and the optic nerve. Perform cycloplegic refraction on all children by using the retinoscope and loose lenses. In cases of amblyopia, early treatment by patching the normal eye is the mainstay of treatment. Surgery may be required if the esodeviation becomes refractory to optical treatment.
Surgery often is needed when treatment is delayed.
Surgical treatment typically entails recession or weakening of the inward-pulling medial rectus muscle in each eye. In cases involving amblyopia, surgery can be limited to only the amblyopic eye by performing a recession of the medial rectus and a resection or strengthening of the lateral rectus. Surgery is performed for the nonaccommodative component only. The operation is not intended to discontinue use of glasses. Typically, stable patients are seen every 6 months.