According to a Cochrane review of 2012, controversies remain regarding type of surgery, non-surgical intervention and age of intervention. The aims of treatment are as follows: * The elimination of any amblyopia * A cosmetically acceptable ocular alignment * Long-term stability of eye position * Binocular cooperation Initially It is essential that a child with strabismus is presented to the ophthalmologist as early as possible for diagnosis and treatment in order to allow best possible monocular and binocular vision to develop. Initially, the patient will have a full eye examination to identify any associated pathology, and any glasses required to optimise acuity will be prescribed – although<unk>  is not typically associated with refractive error. Studies have found that approximately 15% of<unk>  patients have accommodative<unk> . For these patients, antiaccommodative therapy (with spectacles) is indicated before any surgery as antiaccommodative therapy fully corrects their<unk>  in many cases and significantly decreases their deviation angle in others. Amblyopia will be treated via occlusion treatment (using patching or atropine drops) of the non-squinting eye with the aim of achieving full alternation of fixation. Management thereafter will be surgical. As alternative to surgery, also botulinum toxin therapy has been used in children with<unk> . Furthermore, as accompaniment to ophthalmologic treatment, craniosacral therapy may be performed in order to relieve tension (see also: Management of strabismus). Surgery Controversy has arisen regarding the selection and planning of surgical procedures, the timing of surgery and about what constitutes a favourable outcome. 1. Selection and planning Some ophthalmologists, notably Ing and Helveston, favour a prescribed approach often involving multiple surgical episodes whereas others prefer to aim for full alignment of the eyes in one procedure and let the number of muscles operated upon during this procedure be determined by the size of the squint. 2. Timing and outcome This debate relates to the technical anatomical difficulties of operating on the very young versus the possibility of an increased potential for binocularity associated with early surgery. Infants are often operated upon at the age of six to nine months of age and in some cases even earlier at three or four months of age. Some emphasize the importance of intervening early such as to keep the duration of the patient's abnormal visual experience to a minimum. Advocates of early surgery believe that those who have their surgery before the age of one are more likely to be able to use both eyes together post-operatively. A Dutch study (ELISSS) compared early with late surgery in a prospective, controlled, non-randomized, multicenter trial and reported that: Children operated early had better gross stereopsis at age six as compared to children operated late. They had been operated more frequently, however, and a substantial number of children in both originally-recruited groups had not been operated at all. Other studies also report better results with early surgery, notably Birch and Stager and Murray et al. but do not comment on the number of operations undertaken. A recent study on 38 children concluded that surgery for<unk>  is most likely to result in measureable stereopsis if patient age at alignment is not more than 16 months. Another study found that for children with<unk>  early surgery decreases the risk of dissociated vertical deviation developing after surgery. Aside the strabismus itself, there are other aspects or conditions that appear to improve after surgery or botulinum toxin eye alignment. Study outcomes have indicated that after surgery the child catches up in development of fine-motor skills (such as grasping a toy and handling a bottle) and of large-muscle skills (such as sitting, standing, and walking) in case a developmental delay was present before. Evidence also indicates that as of the age of six, strabismic children become less accepted by their peers, leaving them potentially exposed to social exclusion starting at this age unless their eye positioning is corrected by this time (see also: Psychosocial effects of strabismus).
Infantile esotropia
Dissociated vertical deviation
Ectopia cordis
Cerebral achromatopsia
Ametropic amblyopia
Nonsyndromic deafness
Lipoatrophia semicircularis
Cystic eyeball