Diagnosis of a non-paralytic squint is as follows:
The commonest cause of misdiagnosis of esotropia is epicanthus, some degree which exists in all infants and which may be prominent in a minority of cases. This falsely gives the impression of esotropia as it reduces the amount of visible white sclera nasal to the cornea. A test of corneal light reflexes, combined with the cover test will differentiate these from cases of true squint.
Mydriasis is an important component of examination and allows an objective determination of the refractive state of the eyes and the mydriasis allows adequate examination to exclude organic causes of poor vision and consequent squint e.g. macular scarring, optic atrophy, retinoblastoma, cataract etc.
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