Preoperative evaluation of the strabismus patient

The preoperative evaluation of the strabismus patient may require one or several examination sessions. Since general anesthesia is most often employed, the patient's general health, hematological and neurological status, and concurrent medications should be evaluated. The age of onset and whether the deviation was intermittent in character for some part of its course are important clues to fusion potential. The examination should emphasize close observation of the eyes when they are stationary and during rotations; it should be conducted so as to encourage, rather than frustrate, binocular cooperation. This requires test selection that takes into account both variations in alignment (at different test distances) and amblyopia. Sensory evaluation can involve many tests, but specifically for surgical planning it can be brief and apply principal to justification of surgery for small-angle, nonsymptomatic deviations. The phenomenon of intractable diplopia is unusual and probably should not be considered a strong deterrent to surgical correction of a long-standing and cosmetically unpleasant misalignment.