Which finding might indicate an issue with muscle function affecting strabismus?

Exophthalmos, which refers to the protrusion of the eye or eyes, is a significant finding that might indicate an issue with muscle function affecting strabismus. In the context of strabismus, which is a condition where the eyes do not properly align with each other, exophthalmos can suggest underlying problems such as muscle weakness, paralysis, or other structural abnormalities within the orbit.

The muscles that control eye movement can become compromised due to various conditions, including trauma, inflammation, or thyroid disease (such as graves' disease), leading to the outward displacement of the eye. When the muscles that retract or stabilize the eyeball are not functioning correctly, this can result in an abnormal position of the eye, contributing to strabismus.

On the other hand, enophthalmos—where the eye is sunken into the orbit—typically suggests issues such as atrophy of the orbital fat or other structural changes, which don't directly relate to muscle function causing misalignment. Likewise, orbital pressure, while an important factor in ocular health, does not specifically point to dysfunction of the extraocular muscles affecting strabismus. Normal reflexes indicate functioning neural pathways but do not provide information about the muscle's ability to control the eye's position