Claire has brought her 24 month old daughter Molly to the GP as she is concerned about her right eye turning inwards. She first noticed it a few months ago. Molly was born at 36 weeks by emergency C-section for Pre-eclampsia and does not have any significant medical problems. Claire informs you that both herself 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.
What is the most suitable next step?