Incidence of Strabismus and Amblyopia in Preverbal Children Previously Diagnosed with Pseudoesotropia

Abstract

Background and Purpose

We previously reported that 12% of children under age 3 diagnosed with pseudoesotropia without significant refractive error later developed strabismus or mild refractive amblyopia. Mohan and Sharma recently reported on fifty-one patients with pseudoesotropia and hyperopia and noted that esotropia developed in 53.9% of the children with > 1.50 D of hypermetropia compared to 2.6% of those who had ≤ 1.50 D hypermetropia, implying a low risk of esotropia unless hyperopia was greater than 1.50 D on initial exam. We reviewed our data to see if we had similar findings in our patients.

Method

Medical records between January 1, 2001, and February 26, 2010, were reviewed retrospectively. Three hundred ninety-four patients diagnosed with pseudoesotropia with an otherwise normal examination were reviewed, and 253 with follow-up were analyzed.

Results

Forty-six children were 36 months or older at initial presentation; none developed strabismus; 207 children were <36 months at initial presentation; twenty-two children (11%) were later found to have strabismus. Seventy-eight of these children had hyperopia > 1.50 D; eight children (10%) later developed strabismus. One hundred twenty-nine children had hyperopia ≤ 1.50 D, and fourteen (11%) developed strabismus. Our analysis showed an equal risk of strabismus developing in pseudoesotropia patients under age 3 with greater or less than 1.50 D of hyperopia.

Conclusion

There is a significant risk of esotropia developing in children under three diagnosed with pseudoesotropia. Hyperopia less than 1.50 D, does not obviate the need for careful follow-up.

• pseudoesotropia
• esotropia
• refractive error
• amblyopia