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Does neonatal ocular misalignment predict later abnormality?

A Horwood1, B Williams

  • 1Orthoptic Department, Royal Berkshire Hospital, Reading, UK. a.m.horwood@reading.ac.uk

Eye (London, England)
|January 5, 2002
PubMed
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Frequent neonatal squinting, or ocular misalignment, in infants significantly increases the risk of needing glasses for refractive errors like hypermetropia and myopia by age five. Occasional squinting is considered normal infant behavior.

Area of Science:

  • Ophthalmology
  • Developmental Pediatrics
  • Neonatology

Background:

  • Neonatal ocular misalignments, commonly known as squint, are frequently observed in newborns.
  • The long-term visual significance of these early misalignments requires further investigation.

Purpose of the Study:

  • To determine the significance of neonatal ocular misalignments.
  • To investigate the visual outcomes associated with neonatal squint.

Main Methods:

  • A longitudinal prospective study of 1150 infants was conducted.
  • Infants were classified based on the frequency of ocular misalignment (squint) in the first 8 weeks of life: 'often', 'occasionally', or 'never'.
  • Data were analyzed using Chi2 and Fisher's exact tests and ANOVA, comparing visual outcomes from pre-school vision screening and hospital records.

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Main Results:

  • Frequent neonatal squinting (7.7% of subjects) was significantly associated with needing spectacles for hypermetropia (p=0.04) and myopia (p=0.05).
  • Frequent squinters showed a higher incidence of significant esodeviation (p=0.04) and were more likely to be premature (p=0.05).
  • While trends suggested more myopic and oblique astigmatism in the 'never' group, esotropias in the 'often' group were more frequently intermittent.

Conclusions:

  • Occasional neonatal squinting is considered normal infant behavior.
  • Frequent neonatal squinting triples the risk of developing significant esodeviation or refractive errors requiring spectacles by age five.
  • The overall incidence of significant abnormality in frequent squinters does not exceed 9%.