Incidence of strabismus and amblyopia in preverbal children previously diagnosed with pseudoesotropia.

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.

Incidence of strabismus and amblyopia in preverbal children previously diagnosed with pseudoesotropia.

PURPOSE: To determine how frequently children diagnosed with pseudoesotropia before 3 years of age are later found to have true strabismus or amblyopia. METHODS: Records of all patients presenting to one pediatric ophthalmologist between January 1, 2001, and February 26, 2010, were reviewed retrospectively. Patients diagnosed with pseudoesotropia who had an otherwise normal examination were included. RESULTS: A total of 306 patients were diagnosed with pseudoesotropia with no significant refractive error on initial examination. Of these, 201 had the follow-up examination recommended for all 306 patients. The average age at the time of the initial examination was 13 months (range, 2-33). The average age at follow-up was 33 months (range, 4-120). Of the 201 patients, 20 were later found to have strabismus (10%) and 5 were later found to have significant refractive error and mild refractive amblyopia (2%). Of the 20 children found to have strabismus, 15 had esodeviation, 3 had exodeviation, 1 had Duane syndrome, and 1 had Prader-Willi syndrome with esotropia. CONCLUSIONS: Of children initially diagnosed with pseudoesotropia under age 3 who returned for follow-up, 12% were later found to have strabismus or mild refractive amblyopia. The ultimate prevalence of strabismus or amblyopia was higher in children diagnosed with pseudoesotropia than would be expected in the general population.