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Protocol of Examination of Squint

The examination of squint may be summarized in the steps mentioned below:

1. Introduction
2. Visual acuity, best corrected visual acuity, (if less than 8 yrs cycloplegic refraction)

3. Torch Examination:

  • Hirschbergs test
  • Pseudostrabismus
  • AHP
  • Pupil (direct, consensual, RAPD)
  • Epicanthus, telecanthus
  • Ocular torticollis

4. Extraocular Movements:

  • Versions
  • Vergence
  • Belchosky
  • Diplopia
  • Ductions if any obstruction in versions
  • Saccades
  • Duane’s retraction
  • Nystagmus



5. Cover Tests:

Cover, uncover, alternate cover and uncover test

i.      Distant with glasses
ii.     Near without glasses

6. Amount of Deviation:

a. Prism cover test (Manifest squint)
b. Maddox rod/wing (Ptosis)

Non Paralytic Squint Binocular functions Paralytic Squint
BSVTitmus/TNO/ synoptophore Examination of Cranial Nerves:CN V : Sensation of face and muscles of mastication
Suppresion/ suppression scotoma  CN VII Frowning, close eyes, show teeth, blow air in mouth
4 prism diopter base out test  CN VIII Click on both ears
Worth four dot  CN III Tremor, hemiparesis, gait
Bagolini Striated glasses
Fixation David star

7. Slit Lamp examination:
Anterior segment for sensory deprivation EXO/ESO

8. Fundoscopy:

9. Thank the patient

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