Congenital esotropia and the risk of mental illness by early adulthood.

OBJECTIVE: The purpose of this study is to investigate whether children with congenital esotropia (CET) are more likely than controls to develop mental illness by early adulthood. DESIGN: Retrospective, population-based cohort. PARTICIPANTS: Children (aged <19 years) diagnosed with CET while residing in Olmsted County, Minnesota, from January 1, 1965, to December 31, 1994, and their 1-to-1 non-strabismic birth- and gender-matched controls. METHODS: The medical records of patients with esotropia and their controls were retrospectively reviewed for the subsequent development of psychiatric disease. MAIN OUTCOME MEASURES: The development of mental illness and associated comorbidities among patients with CET and their controls. RESULTS: A mental health disorder was diagnosed in 42 (33%) of the 127 patients with CET followed to a mean age of 20.4 years compared with 16% of controls (P = 0.002). Congenital esotropia increased the odds of developing a psychiatric illness 2.6 times (confidence interval, 1.5-4.8) compared with controls. The number of mental health diagnoses (P = 0.019) and the use of psychotropic medications (P = 0.015) were significantly more common among esotropic patients compared with non-strabismic controls. CONCLUSIONS: Congenital esotropia, similar to those with intermittent exotropia or convergence insufficiency, increases the odds of developing mental illness by early adulthood 2.6 times compared with controls. The cause of this association does not seem to be associated with premature birth. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Is the incidence of infantile esotropia declining?: a population-based study from Olmsted County, Minnesota, 1965 to 1994.

OBJECTIVE: To investigate the incidence of infantile esotropia from a defined population in the United States over a 30-year period. Recent reports from the United Kingdom have suggested that strabismus or strabismus surgery is occurring less frequently today than in previous years. METHODS: The medical records of all patients diagnosed with infantile esotropia within Olmsted County, Minnesota, from January 1, 1965, through December 31, 1994, were retrospectively reviewed. RESULTS: The birth prevalence of infantile esotropia during the 30-year period was 25 (95% confidence interval, 21-29) per 10 000, or 1 in 403 live births. Although there were slightly more cases of infantile esotropia in the earlier years (45 from 1965-1974, 51 from 1975-1984, and 34 from 1985-1994), the change in incidence over time was not statistically significant (P = .32). The mean number of surgeries performed on each patient in this cohort was similar during the 30-year study: 1.8 for those diagnosed from 1965 to 1974, 1.9 for 1975 to 1984, and 1.6 for 1985 to 1994. CONCLUSIONS: The incidence of infantile esotropia in this population has not significantly changed from 1965 through 1994. Moreover, the rate of surgical intervention over these years is similar for this patient population.

Long-term follow-up of congenital esotropia in a population-based cohort.

PURPOSE: To report the long-term outcomes of a population-based cohort of children diagnosed with congenital esotropia during a 30-year period. METHODS: The medical records of all patients diagnosed with congenital esotropia as residents of Olmsted County, MN, from January 1, 1965, through December 31, 1994, were retrospectively reviewed. RESULTS: A total of 130 children were diagnosed during the 30-year period at a median age of 7.4 months with a mean deviation of 30(Delta). During a median follow-up of 11.9 years, 126 patients underwent a mean of 1.8 strabismus surgeries. The risk for undergoing a second surgery was significantly greater in patients with a larger presenting angle (p = 0.017) and a younger age at first surgery (p = 0.006). The Kaplan-Meier rate of having a second surgery was 51% at 10 years and 66% at 20 years. For those with 6 weeks or more of follow-up from the final surgery, last examined at a mean age of 15.1 years, 42 of 94 (45%) were within 8(Delta) of orthotropia and 30 of 98 had some level of stereopsis (

Episcleral melanoma as a complication of ocular melanocytosis.

BACKGROUND: Primary episcleral melanoma is exceedingly rare. We report a case of primary episcleral melanoma in an eye with ocular melanocytosis. METHODS: Interventional case report with presentation of clinical photographs and histopathology. RESULTS: A 62-year-old man with long-standing ocular melanocytosis presented with a new, raised, darkly pigmented lesion on the episclera. Clinical examination and ultrasound biomicroscopy showed no evidence of intraocular mass or nevus. Lamellar scleroconjunctivectomy of the lesion was performed, and histopathologic analysis revealed episcleral melanoma with no evidence of intra- or extra-ocular extension. He was later treated with cryotherapy to the surgical bed. Continued observation shows no evidence for intraocular tumor or recurrence of episcleral tumor. CONCLUSIONS: Primary episcleral melanoma is a previously unreported complication of ocular melanocytosis, and should be considered in the differential diagnosis in patients with ocular melanocytosis and pigmented nodules on the ocular surface.

Correlation of grating acuity with letter recognition acuity in children with albinism.

PURPOSE: This study was undertaken to determine whether grating acuity in early childhood can be used as a predictor of letter recognition acuity in patients with albinism. METHODS: In this retrospective study, we compared the binocular grating acuities of children with albinism (30 at age 1, 29 at age 2, and 19 at age 3) to their letter recognition acuity at age 4-6 years. RESULTS: Mean binocular grating acuity was 2.0, 1.9, and 1.5 octaves below age matched norms at ages 1, 2, and 3 years, respectively (P<0.001 at all ages). Mean grating acuity at ages 1, 2, and 3 correlated moderately (r=0.458, 0.502, and 0.471, respectively; all with P<0.05) with mean binocular letter recognition acuity of the same children at ages 4-6. A subgroup analysis of 9 patients followed longitudinally showed strong correlation of binocular grating acuity at ages 1 and 2 with letter acuity (r=0.745, P=0.021; r=0.930, P<0.001, respectively) and moderate correlation at age 3 (r=0.685, P=0.042). In the larger group and the longitudinal subgroup, mean binocular grating acuity at ages 1 and 2 was worse than mean binocular letter recognition acuity at age 4-6 (paired-samples t-test, P<0.001). Mean binocular grating acuity at age 3 in both groups was not significantly different than mean binocular letter recognition acuity at age 4-6 (paired-samples t-test, P=0.790, 0.215, respectively). CONCLUSION: Parents should be informed that vision measured as grating acuity at age 3 provides an estimate of future letter recognition acuity in children with albinism.