An infant with asymmetrical gaze requires ophthalmology referral if which finding is present?

• A. He has persistent strabismus
• B. He is 2 months of age
• C. He is 3 months of age
• D. His red reflex is normal

Answer: (A)

In infants, a lasting misalignment of the eyes signals a potential strabismus that can threaten binocular vision and lead to amblyopia if not evaluated and treated. While newborns can show brief or intermittent misalignment as coordination develops, most babies’ eyes align by about 3 to 4 months. If the gaze remains asymmetrical beyond that period, it’s a true indicator that needs ophthalmology assessment to determine the cause and appropriate treatment.

Having an age like 2 or 3 months isn’t by itself a reason for referral, since developmental alignment can vary in early months. A normal red reflex is reassuring regarding the health of the eye’s media but doesn’t address whether the eyes are truly aligned. Therefore, persistent strabismus is the finding that most clearly warrants referral.