Ophthalmic Education:

International Curriculum Guidelines on Medical Student Education in Ophthalmology: 3. Pediatric Ophthalmology and Strabismus

On this page:

• i) Anatomy of the Extraocular Muscles and their Fascia
  
  
• ii) Amblyopia**
  
  
• iii) Strabismus**
  
  
• iv) Examination of the eyes
  
  
• v) Strabismus Testing
  
  
• vi) Leukocoria*
  
  
• vii) Management or referral**
  
  
• Competencies*
  
  
• Educational Priorities

The International Council of Ophthalmology Task Force on Medical Student Education in Ophthalmology

Draft, September 16, 2003

I. Anatomy of the Extraocular Muscles and their Fascia

1. Origin, course, insertion, innervation, and action of the extraocular muscles
   
   1. Horizontal rectus muscles*
      
   2. Vertical rectus muscles*
      
   3. Oblique muscles*
      
   4. Levator palpebrae superioris muscle*
      
   5. Insertion relationships of the rectus muscles*
2. Blood supply of the Extraocular muscles***
   
   1. Arterial
      
   2. Venous
      
3. Fine structure of the extraocular muscles**
   1. Fiber types
4. Anatomical implications

II. Amblyopia**

1. Strabismic amblyopia
   
2. Refractive amblyopia
   
3. Form deprivation and occlusion amblyopia

III. Strabismus**

1. Concomitant strabismus
   
2. Incomitant strabismus
   
3. Heterotropia
   1. Esophoria: inward deviation - not manifest**
      
   2. Esotropia: inward deviation - manifest*
      
   3. Exophoria: outward deviation - not manifest**
      
   4. Exotropia: outward deviation*- manifest
      
   5. Hyperphoria: upward deviation - not manifest**
      
   6. Hypertropia: upward deviation*- manifest*
      
   7. Hypophoria: downward deviation - not manifest**
      
   8. Hypotropia: downward deviation* -manifest

IV. Examination of the eyes

1. Visual acuity and amblyopia***
   1. Newborns
      
   2. Infants to 2 years old**
      
   3. 2 to 4 years old**
      
   4. 4 to 5 and up**

V. Strabismus Testing

1. General Inspection*
   
2. Corneal light reflex*
   
3. Cover test**
   
4. Other tests**
   1. Red reflex
      
   2. Ophthalmoscopy
      
   3. Pupillary testing

VI. Leukocoria*

1. Retinoblastoma*
   
2. PHPV***
   
3. ROP**
   
4. Cataract**

VII. Management or referral**

1. Amblyopia
   
2. Strabismus
   
3. Leukocoria

Competencies*

• Student should
  • Perform visual acuity testing in each eye in preverbal children by fixation and recognizing fixation preference if present.***
    
  • Measure visual acuity in children 2-5 years with Allen cards with each eye.***
    
  • Recognize and characterize ocular misalignment (strabismus) by performing Hirschberg testing*
    
  • Recognize leukocoria and importance*
    
  • Understanding referral for leukocoria, amblyopia, and strabismus in a child as an urgent issue*

Educational Priorities

In the listing above, essential ophthalmic knowledge and clinical eye care skills are marked with a single asterisk *. This material is basic for all international medical student education.

Information that reflects a greater level of understanding is marked with two asterisks**.

Areas of cognitive and clinical skills that are more appropriate for students who seek further training in ophthalmology are marked with three asterisks***.

While important to ophthalmic care, the Task Force does not regard the cognitive or skill set designated ** or *** as essential to the basic curriculum of most international medical students.

Next: 4. Neuro-Ophthalmology

Also see:

• Introduction to the "International Curriculum Guidelines on Medical Student Education in Ophthalmology"
  
  
• Table of Contents for the Curriculum
  
  
• Education of Medical Students in Ophthalmology