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Molly has just turned two years old. Her mum, Claire has brought her to see you as she is concerned about her right eye turning inwards. She first noticed it a few months ago but hasn’t had time to make an appointment for review. Molly was born at 32 weeks by emergency C-section for Pre-eclampsia, her birth weight was 1.9kg, she was in newborn intensive care unit for four weeks and doesn’t have any significant medical problems. Molly is up to date with immunisations. Claire informs you that both her and Molly’s dad wear glasses for driving but deny any other significant family history.

On examination, Molly’s eyes including pupils look symmetrical. On performing the corneal reflex test, you can see that the light is not reflected in the same place on both corneas. Cover test was very difficult to do as Molly found it difficult to follow instructions. However, it is clear that a manifest squint is present. On covering the left eye, Molly’s right eye moves to fixate on a nearby object.

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