# A nurse is assessing a 4-year-old child for strabismus. Which assessment finding would be most indicative of this condition? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=542563 > language: ko > subject: Child Health ## 문제 A nurse is assessing a 4-year-old child for strabismus. Which assessment finding would be most indicative of this condition? ## 보기 1. The child complains of eye pain when looking at bright lights 2. The child has difficulty reading small print on an eye chart 3. The child shows signs of increased tearing from both eyes 4. The child's eyes do not appear to be aligned when looking straight ahead **✔ 정답** **정답: 4** ## 해설 Strabismus is characterized by misalignment of the eyes. The most indicative finding is visible misalignment when looking straight ahead, as in option 4. Other options describe symptoms not specific to strabismus. ## 심화 해설 Correct Answer: 4 The most indicative clinical finding of strabismus in a 4-year-old child is that the child's eyes do not appear to be aligned when looking straight ahead. This finding directly reflects the fundamental definition of the condition. Strabismus is defined by a misalignment of the eyes. When a child with typical eye alignment looks straight ahead with the head held in a primary position, both eyes fixate equally on the same object. In strabismus, this coordination is lost. One or both eyes may deviate inward (esotropia) or outward (exotropia), creating a visible lack of alignment relative to the direction of the focused object [1]. This misalignment is the hallmark sign that nurses and healthcare providers observe during a physical assessment. The underlying causes can include refractive errors, abnormalities in binocular fusion (the brain's ability to combine images from both eyes into one), or neuromuscular anomalies affecting eye movements [1]. When you perform a cover test or simply observe the child's gaze, the visible deviation of one eye is the primary and most direct indicator of strabismus. The other options describe findings that are not specific or primary indicators of strabismus. Complaints of eye pain when looking at bright lights (photophobia) are more commonly associated with conditions like uveitis, keratitis, or meningitis. Difficulty reading small print on an eye chart is a sign of reduced visual acuity, which may be caused by refractive errors such as myopia, but it is not the defining characteristic of eye misalignment. While strabismus can lead to amblyopia and subsequent vision loss if untreated, the immediate assessment finding is the misalignment itself, not the secondary complaint of poor vision. Increased tearing from both eyes (epiphora) is typically related to nasolacrimal duct obstruction, allergies, or infection, not the neuromuscular or refractive causes of strabismus. It is important to note that while objective screening tools like the Spot Vision Screener are useful for detecting refractive errors and amblyopia risk factors, their ability to detect strabismus, particularly accommodative esotropia, can be limited [2]. A case series documented instances where the screener failed to detect ocular misalignment in children under three years of age, indicating only mild hyperopia while a clinically significant strabismus was present [2]. This underscores why a direct physical assessment of eye alignment remains a critical nursing skill, as technology cannot yet replace the observation of whether the eyes appear aligned when the child looks straight ahead.References (research sources) - [1]StrabismusResearch articleKaur K, Kanukollu VM, Gurnani B. (2026) - [2]Esotropia Missed During Pre-health Checkup Screening With the Spot Vision Screener: A Case Series.Case reportFuseya K, Matsumoto T, Matsumura S, Kawakami M, Chiba E, Tomita M, Kunugi Y, Hori Y. (2026) · DOI: 10.7759/cureus.104609 ## 임상 시나리오 Clinical Assessment of Strabismus in a Pediatric Patient A 4-year-old child presents for a routine well-child examination. The nurse observes the child's eyes while the child is looking straight ahead at a toy. The corneal light reflex is not symmetric, and one eye appears to deviate inward. The mother reports no complaints of pain or tearing but mentions the child sometimes squints when looking at distant objects. Nursing Actions and Rationale - **Perform the Cover-Uncover Test:** While the child fixates on a near object, cover one eye. Observe the uncovered eye for any movement to take up fixation, which indicates a tropia. Repeat on the other eye. This objectively confirms the misalignment. - **Assess Visual Acuity:** Use an age-appropriate chart (e.g., LEA symbols or HOTV) to check each eye individually. Strabismus can lead to amblyopia if the brain suppresses the image from the deviating eye. - **Document the Deviation:** Note the direction (inward, outward, upward, downward), frequency (constant or intermittent), and which eye is affected. This information is critical for the ophthalmologist's treatment plan. - **Educate the Family:** Explain that strabismus is not something the child will outgrow. Early intervention with glasses, patching, or surgery is essential to prevent permanent vision loss from amblyopia. Key Clinical Pearls The hallmark sign of strabismus is a visible misalignment of the eyes in primary gaze. Do not rely on symptoms like eye pain or tearing, as these are not primary indicators. Any suspected misalignment in a child warrants a prompt referral to a pediatric ophthalmologist. ## 핵심 개념 - **Strabismus** — A condition in which the eyes are not properly aligned with each other, resulting in one eye deviating inward (esotropia) or outward (exotropia). - **Esotropia** — A form of strabismus where one or both eyes turn inward toward the nose. - **Exotropia** — A form of strabismus where one or both eyes turn outward away from the nose. - **Cover Test** — A clinical assessment where one eye is covered while the patient fixates on an object, and the uncovered eye's movement is observed to detect misalignment. - **Binocular Fusion** — The brain's ability to combine the separate images from each eye into a single, three-dimensional perception. ## 같은 주제 문제 - [A nurse is assessing a 4-year-old child for strabismus. 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