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Paralytic Strabismus in Turkish Children Examined at Three Tertiary Care Services: A Retrospective Cohort Study
Insights
Pediatric paralytic strabismus, often caused by trauma or undetermined factors, affects children under 18. The fourth cranial nerve is most frequently impacted, highlighting the need for better clinical management.
Area of Science:
- Ophthalmology
- Pediatric Neurology
- Cranial Nerve Disorders
Background:
- Strabismus is a common condition in children, with paralytic strabismus representing a significant subset.
- Ocular motor nerve palsy can lead to paralytic strabismus, impacting visual development and binocularity.
- Understanding the causes and patterns of pediatric paralytic strabismus is crucial for effective diagnosis and management.
Purpose of the Study:
- To determine the etiology and distribution of pediatric ocular motor nerve palsy presenting as paralytic strabismus.
- To analyze the demographic and etiological factors associated with paralytic strabismus in children.
- To provide insights for improved clinical management of pediatric paralytic strabismus.
Main Methods:
- Retrospective analysis of medical records of pediatric patients (<18 years) with suspected strabismus.
- Inclusion criteria: diagnosis of paralytic strabismus and follow-up of at least 6 months.
- Stratification by age, sex, affected cranial nerve, and etiology (congenital, traumatic, neoplastic, post-viral, vascular, undetermined, other).
Main Results:
- Paralytic strabismus was diagnosed in 2.6% of 1,263 pediatric patients.
- The mean age was 5.9 years; 51.5% were boys.
- Acquired causes (63.6%) were more common than congenital (36.4%), with trauma (52.4%) being the leading acquired etiology. The fourth cranial nerve was most frequently affected (45.5%).
Conclusions:
- Trauma and undetermined causes are significant etiological factors in acquired pediatric paralytic strabismus.
- The fourth cranial nerve is the most commonly affected ocular motor nerve in this population.
- Improved understanding of the incidence and etiology can enhance disease management and reduce unnecessary investigations.
Purpose:
To assess the etiology and distribution of pediatric ocular motor nerve palsy manifesting as paralytic strabismus.
Methods:
The authors retrospectively examined the medical files of patients younger than 18 years who were suspected to have strabismus between January 1999 and June 2012 in three Turkish clinics and followed up for at least 6 months. Patients with paralytic strabismus were stratified according to age, sex, affected cranial nerve, and etiology (congenital, traumatic, neoplastic, post-viral, vascular, undetermined, or other), and compared the proportions between groups.
Results:
Paralytic strabismus was observed in 33 of 1,263 patients (2.6%), with a mean age of 5.9 ± 4.4 years (range: 6 months to 16 years). Seventeen patients (51.5%) were boys and 16 (48.5%) were girls. Twelve patients (36.4%) had congenital paralytic strabismus, and 21 patients (63.6%) had acquired strabismus. The most prevalent cause of acquired paralytic strabismus was trauma in 11 patients (52.4%), undetermined in 6 patients (28.6%), post-viral cranial nerve paralysis in 3 patients (14.3%), and a history of hydrocephalus in 1 patient (9.1%). The fourth cranial nerve was the most frequently affected (45.5% [15 of 33]), followed by the sixth (39.4% [13 of 33]) and the third (15.2% [5 of 33]).
Conclusions:
Evaluating the incidence and etiology of paralytic strabismus in children in a clinical setting may improve disease management and reduce unnecessary invasive examinations. This study will assist clinicians in understanding the clinic-based distribution of pediatric paralytic strabismus. [.
