Ten-year review of neuroimaging in acute paediatric strabismus
Cheefoong Chong1,2,3, Natalie Allen1,2,3, Rebecca Jarvis1,2,3
1Ophthalmology Department, Waikato District Health Board, Waikato, New Zealand.
Insights
Acute strabismus in children can be concerning. Non-isolated strabismus warrants neuroimaging, while isolated strabismus may benefit from observation and specialist input.
Area of Science:
- Ophthalmology
- Pediatric Neurology
- Medical Diagnostics
Background:
- Acute childhood strabismus presents diagnostic challenges for ophthalmologists.
- Lack of clear guidelines exists for investigating acute strabismus in children.
- Debate continues regarding initial neuroimaging versus observation for acute strabismus.
Purpose of the Study:
- To outline a standardized approach for investigating acute strabismus in pediatric patients.
- To differentiate investigation pathways based on strabismus presentation.
Main Methods:
- Retrospective chart review of pediatric patients with acute strabismus.
- Inclusion of patients under 18 who underwent neuroimaging.
- Data collected over a 10-year period from two tertiary hospitals.
Main Results:
- 17% of patients had non-isolated strabismus; 75.7% had isolated strabismus.
- Abnormal neuroimaging was found in 70.6% of non-isolated strabismus cases.
- Abnormal neuroimaging occurred in 7.5% of isolated strabismus cases.
Conclusions:
- Acute non-isolated strabismus is a strong indicator of neurological issues, necessitating urgent neuroimaging.
- Isolated acute strabismus may be managed with observation and pediatric/neurology consultation.
Background:
Acute childhood strabismus is often a clinical conundrum faced by ophthalmologists. Currently, there are no clear clinical guidelines on how to investigate a child presenting with acute strabismus. Furthermore, there is no consensus as to whether to initially perform neuroimaging of a child to rule out the small but serious risk of intracranial pathology, or to pursue a careful observational approach. This paper aims to outline a standardised approach to investigating acute strabismus in paediatric patients.
Methods:
A retrospective chart review of all paediatric patients that presented over a 10-year period to the ophthalmology departments at two tertiary level hospitals in New Zealand was conducted. Patients under 18 years of age with an acute presentation of strabismus, who underwent neuroimaging, were included.
Results:
A total of 500 patient records were reviewed. Seventy patients met the study inclusion criteria. Of these patients, 17 (24.3%) had non-isolated strabismus while 53 patients (75.7%) had isolated strabismus. Twelve patients (70.6%) who presented with a non-isolated strabismus had abnormal neuroimaging. Of those who presented with an isolated strabismus, 4 (7.5%) had abnormal neuroimaging.
Conclusions:
Acute onset non-isolated strabismus is a significant predictor of underlying neurological abnormality in children and requires urgent neuroimaging. However, a cautious approach in which there is close observation, along with general paediatric and/or paediatric neurology input, may be appropriate for children presenting acutely with an isolated strabismus.
