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.