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Aim: To evaluate the mydriatic effect of proparacaine hydrochloride (PH) in children undergoing strabismus surgery under general anesthesia (GA)., Methods: This was a pilot, prospective, non-randomized, self-controlled interventional study. Nine children with esotropia or exotropia undergoing horizontal muscle squint surgery under GA at a tertiary eye care center were included. The six Group 1 patients underwent both eye surgeries, while the three Group 2 patients underwent single eye surgery. PH was instilled in one eye of Group 1 patients and both eyes of Group 2 patients. Change in pupil diameter (PD) was analyzed as the main outcome measure., Results: Mean age of the patients was 4.67 ± 2.64 years. In the study eyes, mean average baseline PD was 1.59 ± 0.40 mm (range: 1.06-2.37), while postoperative average PD was 3.99 ± 1.34 mm (range: 1.79-6.02). The mean baseline PC had increased from 5.51 ± 1.09 mm to 12.6 ± 3.58 mm at the end of the surgery. PD and PC increased in all of the study eyes while no change in PD or PC was seen in the control eyes of either of the groups. The dilated pupil was skewed horizontally towards the muscle being operated upon in all of the study eyes., Conclusions: PH has a mydriatic effect of its own. It penetrates through the bare sclera and leads on to skewed dilation of the pupil. Surgeons should consider this effect while judging pupil alignment at the end of the surgery.

Strabismus is one of the most challenging subspecialties encountered in the field of ophthalmology. The concept of etiology of strabismus is being advanced with the development of newer imaging modalities and increased understanding of the genetics of strabismus. Imaging is also being used to aid in the planning of strabismus surgery. Newer horizons are being explored in the amblyopia management. The good old eye-pad is being replaced with the iPad. Early detection of loss of stereopsis is being used to decide the timing for strabismus surgery. Improvement of binocular summation has been discovered as a benefit of corrective strabismus surgery. Newer surgical techniques such as new transposition procedures are being developed to correct complex strabismus. Strabismus surgeries aided by adjustable sutures have increased the precision of a strabismologist. A new light has been thrown on the psychosocial impact of strabismus. A present-day strabismologist has advanced from the goal of ocular alignment to a bigger perspective "to regain the paradise lost: stereopsis."

A 24-year-old man developed cyclic esotropia following vitreoretinal surgery for retinal detachment in his right eye. He underwent right eye medial rectus recession (6 mm) and lateral rectus resection (8.5 mm) under local anesthesia for the correction of cyclic esotropia. Following surgery, he developed a unique pattern of cyclic strabismus that involved alternation between esotropia and exotropia every 24 hours. To treat this condition, the patient underwent lateral rectus recession (8.5 mm) and medial rectus posterior fixation of medial rectus in the right eye. Following surgery, he was corrected for heterotropia on both esotropic and exotropic days., (Copyright © 2017 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

Conversely, in cases of accommodative esotropia, atropine can abolish the esotropia which is attributed to the accommodation apparatus by inducing cycloplegia. Atropine for the treatment of childhood myopia: Safety and efficacy of 0.5%, 0.1%, and 0.01% doses (Atropine for the treatment of myopia 2). Ophthalmology 2012;119:347-54. 6 Kothari M, Modak M, Khan H, Jahan S, Solanki M, Rathod V. Convergence excess consecutive esotropia associated with 0.01% atropine eye drops usage in patients operated for intermittent exotropia. [Extracted from the article]