Skip to main content

Pediatric ophthalmology and strabismus questions for residents

Pediatric ophthalmology and strabismus, BCSC Section 6, spans visual development and amblyopia, the classification and management of esotropia and exotropia, vertical and incomitant deviations, and the eye diseases of infancy and childhood: retinopathy of prematurity, congenital cataract and glaucoma, retinoblastoma, nasolacrimal duct obstruction, and the ocular features of genetic syndromes and systemic disease.

Boards emphasize measurement and interpretation: cover testing, prism measurement, the accommodative convergence to accommodation (AC/A) ratio and cycloplegic refraction. Expect vignettes on the red reflex and leukocoria, the sensitive period for amblyopia treatment, A and V patterns and oblique dysfunction, restrictive and innervational syndromes such as Brown and Duane, and the recognition of abusive head trauma.

When practicing, sketch the deviation before choosing an answer: which eye, which direction, in which gaze position and at what fixation distance. Many questions turn on a single discriminating finding, so read the explanation for every distractor, and use spaced repetition to keep eponymous syndromes, inheritance patterns and ROP classification fresh until exam day. Revisit missed questions until you can explain why each incorrect option fails.

Free pediatrics & strabismus practice questions

Pediatrics & strabismus questions are in the OphthoMentor app: create a free account to practise them with explanations, flowcharts and spaced-repetition review.

High-yield pediatrics & strabismus topics for boards

  • Amblyopia: sensitive period, patching versus atropine penalization, PEDIG trial principles
  • Infantile esotropia: large angle, cross-fixation, DVD, latent nystagmus
  • Refractive accommodative esotropia: full cycloplegic hyperopic correction
  • High AC/A esotropia: near deviation greater than distance, bifocals
  • Intermittent exotropia: distance-near disparity, patch test, tenacious proximal fusion
  • Congenital superior oblique palsy: head tilt, large vertical fusional amplitudes
  • A and V patterns: oblique dysfunction, MALE rule for horizontal rectus transposition
  • Duane syndrome: abducens aplasia, aberrant third nerve innervation, retraction on adduction
  • Brown syndrome: limited elevation in adduction, positive forced duction test
  • Sensory adaptations: suppression, anomalous retinal correspondence, monofixation syndrome
  • Retinopathy of prematurity: ICROP3 zone, stage, plus disease, type 1 treatment criteria
  • Leukocoria differential: retinoblastoma, Coats disease, persistent fetal vasculature, cataract
  • Retinoblastoma: RB1 genetics, heritable versus nonheritable disease, second malignancies
  • Congenital cataract: visual significance, timing of surgery, aphakic optical correction
  • Primary congenital glaucoma: epiphora, photophobia, buphthalmos, Haab striae, angle surgery
  • Congenital nasolacrimal duct obstruction: valve of Hasner, spontaneous resolution, massage, probing
  • Juvenile idiopathic arthritis uveitis: ANA-positive oligoarticular disease, asymptomatic screening
  • Abusive head trauma: multilayered retinal hemorrhages, traumatic retinoschisis, mandatory reporting
  • Strabismus surgery complications: slipped muscle, anterior segment ischemia, scleral perforation

How pediatrics & strabismus is examined

Pediatric ophthalmology and strabismus corresponds to BCSC Section 6. On OKAP and the ABO Written Qualifying Examination, items are typically clinical vignettes built around a child's age, a described alignment and a refraction, asking for the diagnosis, the next step or the relevant surgical principle. Nine-gaze photographs, red reflex images and fundus photographs lend themselves to image-based questions.

The EBO Diploma and FRCOphth written papers cover the same core: amblyopia management, childhood esotropia and exotropia, ROP screening and treatment principles, leukocoria and child safeguarding. Questions reward knowing the evidence behind management decisions, including the major randomized trials in amblyopia, as well as the clinical signs.

In oral examinations, strabismus cases may be presented as gaze photographs or prism cover test results, and the candidate is asked to describe, diagnose and plan. A fixed structure (visual acuity, alignment, motility, binocular status, cycloplegic refraction, then management) carries over directly from written practice to oral case stations.