Infantile strabismus: what is it? Where is it?

Infantile strabismus: what is it?where is it?Many ophthalmologists who have faced the challenging task of teaching medical students have been confronted by the apparent simplicity of the questions presented in this forum.In our own experience one of the most daunting questions that recurrently surfaces is what is really wrong in the patient with strabismus?The simple answer, of course, is it's not in the muscles, it's somewhere in the brain.Although the precise location of the 'somewhere' has yet to be defined, recent clinical and laboratory studies have begun to focus on several systems within the central nervous system that appear to be important in the genesis of congenital or infantile strabismus.T he provocative and crucial thesis of Keiner asserted that at birth illumination of the temporal retina drives the eyes nasal-wards.'0Keiner's thesis fundamentally states that eso- tropia develops as a postnatal consequence of light stimulus on the developing reflex pathways essential for binocularity.Indeed, Keiner went so far as to state that 'all children are born with the potentiality to squint and an almost total dissociation of the two eyes.'This thesis was later developed in more detail in the elegant and thought provoking work of Jampolsky."Jampolsky asserted that 'I offer the hypothesis that very early neonatal visual influences may be responsible for motor misalignment and anomalous motor development.Light stimulus in the premature insufficiently developed eyes