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Strabismus in cerebral palsy: when and why to operate
1From the Department of Ophthalmology, Greater Baltimore Medical Center, Baltimore, Maryland.
Insights
Strabismus is common in children with cerebral palsy (CP), particularly spastic diplegia. Prompt non-surgical treatment is beneficial, with surgery considered for psychosocial and visual outcomes.
Area of Science:
- Ophthalmology
- Pediatrics
- Neurology
Background:
- Cerebral palsy (CP) is the leading cause of childhood physical disability.
- Strabismus, or eye misalignment, is a frequent comorbidity in children with CP.
- Spastic diplegia subtype of CP shows a particularly high incidence of strabismus.
Purpose of the Study:
- To review existing literature on strabismus in pediatric cerebral palsy patients.
- To provide summary data and evidence-based recommendations for managing strabismus in CP.
- To identify gaps in current research regarding long-term outcomes.
Main Methods:
- Comprehensive literature review of studies on strabismus in cerebral palsy.
- Analysis of incidence rates and common types of ocular misalignment.
- Synthesis of data to inform management strategies.
Main Results:
- Strabismus occurs significantly more often in children with CP than in neurotypical children.
- Esotropia is the most prevalent form of strabismus observed in this population.
- Non-surgical interventions show promise and should be initiated promptly.
Conclusions:
- Early intervention for strabismus in CP patients is crucial for optimal outcomes.
- Strabismus surgery may be indicated for functional, psychosocial, and visual rehabilitation.
- Further research is needed on long-term natural history and surgical outcomes.
Abstract:
Cerebral palsy (CP) is the most common physical disability in children. Orthoptists and ophthalmologists who care for children with CP know that strabismus is a common feature. This paper reviews the literature on strabismus in patients with CP, and then provides summary data and recommendations for management of these patients. The incidence of strabismus in patients with CP, especially in patients with spastic diplegia, is much higher than in neurologically normal children. Esotropia is the most common ocular misalignment. CP patients with strabismus benefit from nonsurgical treatment and should be treated promptly. Strabismus surgery should be considered in CP patients for psychosocial reasons as well as for potential successful ocular realignment and restoration of binocular vision. The literature is lacking in a long-term natural history study, prospective strabismus surgery studies, and long-term outcome studies of strabismus management in patients with CP.
