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Kim, Kim, and Lee: Factors Associated with the Development of Strabismus in Children and Adolescents with Organic Ocular Diseases
Original Article

J Korean Ophthalmol Soc 2011;52(6):721-725.

Published online: 31 August 2011

DOI: https://doi.org/10.3341/jkos.2011.52.6.721

Factors Associated with the Development of Strabismus in Children and Adolescents with Organic Ocular Diseases

In Geun Kim, MD1, Sang Hyun Kim, MD2, Soo Jung Lee, MD, PhD2

1Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea

2Department of Ophthalmology, Haeundae Paek Hospital, Busan, Korea

Address reprint requests to Soo Jung Lee, MD, PhD, Department of Ophthalmology, Haeundae Paek Hospital #1435 Jwa 1-dong, Haeundae-gu, Busan 612-030, Korea Tel: 82-51-797-0100, Fax: 82-51-462-3534, E-mail: kris9352@daum.net

Received 27 April 2010       Revised 31 December 2010       Accepted 4 April 2011

Copyright © 2011 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate risk factors associated with the development of strabismus in children with organic ocular diseases.

Methods

The authors reviewed the medical records of 143 patients diagnosed with organic ocular disease between the ages of six months and 19 years from March 2000 through September 2009. The distributions of etiology, age, visual acuity and visual acuity difference between both eyes at onset of visual loss, spherical equivalent difference between both eyes, duration of visual loss, and nystagmus were analyzed to determine relationships with the development of strabismus.

Results

Of 143 patients, strabismus developed in 41 children (28.7%). The causative diseases were congenital cataract (73.2%), developmental cataract (7.3%), uncorrected aphakia (7.3%), retinal detachment (4.9%), lens subluxation (2.4%), optic nerve disorder (2.4%), and corneal opacity (2.4%). The incidence of strabismus increased significantly in the cases of congenital disease, those ≤ five years of the age at onset of visual loss, those with ≤ 20/200 visual acuity, and those with large interocular spherical equivalent difference. There was no relationship between incidence of strabismus and visual acuity difference between both eyes. However, the incidence of strabismus increased significantly when the visual acuity difference was more than three Snellen lines in congenital ocular disease.

Conclusions

When ocular disease is congenital, an increased risk of onset of strabismus should be considered when the age at onset of visual loss is less than five years, when visual acuity is below 20/200, and when there is a large spherical equivalent difference between both eyes.

Keywords: Organic, Spherical equivalent, Strabismus, Visual acuity, Visual loss

References

1. Jin YH. Strabismolology. 3nd ed.Ulsan: UUP;2001. p. 115.
2. Havertape SA, Cruz OA, Chu FC. Sensory strabismus–eso or exo? J Pediatr Ophthalmol Strabismus. 2001; 38:327–30.
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Table 1.
Distribution of organic ocular diseases based on the presence of strabismus
Disease No. of patients (%)
No strabismus Strabismus Total
Congenital cataract 58 (56.9) 30 (73.2) 88 (61.5)
Developmental cataract 25 (24.5) 3 (7.3) 28 (19.6)
Retinal detachment 12 (11.8) 2 (4.9) 14 (9.8)
Lens subluxation 5 (4.9) 1 (2.4) 6 (4.2)
Uncorrected aphakia 1 (1.0) 3 (7.3) 4 (2.8)
Optic nerve disorder 1 (1.0) 1 (2.4) 2 (1.4)
Corneal opacity 0 (0.0) 1 (2.4) 1 (0.7)
Total 102 (100.0) 41 (100.0) 143 (100.0)
Table 2.
Relationship between age at onset of organic diseases and onset of strabismus
Age (yr) No. of patients (%)
No strabismus Strabismus p-value
≤5 48 (47.1) 32 (78.0)  
>5 54 (52.9) 9 (22.0) 0.001
Total 102 (100.0) 41 (100.0)  

n = 143, Chi-square test.

Table 3.
Relationship between visual acuity of the eye with organic disease and the onset of strabismus
Visual acuity (Snellen scale) No. of patients (%)
Congenital
 Acquired
No strabismus Strabismus p-value No strabismus Strabismus p-value
>20/200 31 (56.4) 1 (4.6)   31 (81.6) 2 (33.3)  
20/400-20/200 15 (27.3) 12 (54.5)   5 (13.2) 2 (33.3)  
HM* or FC† or LP‡ 8 (14.5) 5 (22.7) 0.001 2 (5.2) 2 (33.3) 0.027
Poor fixation 1 (1.8) 4 (18.2)   0 (0.0) 0 (0.0)  
Total 55 (100.0) 22 (100.0)   38 (100.0) 6 (100.0)  

n = 121, Chi-square test.

* HM = hand motion

† FC = finger counting

‡ LP = light perception.

Table 4.
Relationship between visual acuity difference of both eyes and the onset of strabismus
Visual acuity difference (Snellen line) No. of patients (%)
Congenital
 Acquired
No strabismus Strabismus p-value No strabismus Strabismus p-value
≤2 23 (51.1) 1 (7.7)   6 (15.8) 2 (33.3)  
≥3 22 (48.9) 12 (92.3) 0.009 32 (84.2) 4 (66.7) 0.630
Total 45 (100.0) 13 (100.0)   38 (100.0) 6 (100.0)  

n = 102, Chi-square test.

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