[Oculomotor and visual sensory changes in the neurologically lesioned child].

Pathological changes in the visual system are often present in children with neurological handicaps. Strabismus, refractive errors, amblyopia, optic atrophy are the more frequent findings. The ophthalmological evaluation in these children includes: eliciting of pupillary light reflex; occlusion test; cover-test; observation of symmetry of corneal light reflexes; retinoscopy and ophthalmoscopy. Strabismus is the most frequent alteration. The so-called "caotic" strabismus, with very variable angle of squint and abnormalities of the vertical movements, is peculiar in children with neurological handicaps. Sensorial adaptation to strabismus can lead to: suppression, lack of fusion power, anomalous retinal correspondence, amblyopia; these sequelae are the same as those found in strabismic patients without neurological lesions. The basic aims of therapy are an energetic treatment of sensorial anomalies of strabismus, and the development of the best possible visual acuity in each eye. Surgical treatment has mainly cosmetic purposes. It tends to be delayed in time because the results are rather impredictable, owing to the variations of the angle of squint. It is stressed that surgical and non-surgical treatment of strabismus in children with neurological handicaps has no influence on their psycho-motor performances.