Types of refractive errors in a sample of Iraqi children with Intermittent exotropia

One of the most common strabismus types in children is intermittent exotropia (IXE), which predominantly occurs in children between the ages of 2-4 years. It may affect visual development and often coexists with refractive errors. Unlike esotropia, which is typically associated with hyperopia, IXE demonstrates a more complex relationship with refractive errors. Recent studies suggest a possible link with myopia; however, this relationship remains unclear. This study will investigate the prevalence and distribution of refractive errors in children with IXE, challenging the traditionally held relationship between strabismus and hyperopia and its possible contribution to the development of myopia.

In this cross-sectional retrospective study from August 2021 to December 2023, 179 patients diagnosed with IXE were recruited via an outpatient clinic in Najah Al-Quraishi, Baghdad, Iraq. The refractive errors were compared by autorefractometry and retinoscopy after cycloplegic dilation. Data analysis was conducted under the use of IBM SPSS V.26 for the determination of emmetropia, myopia, and hyperopia prevalence.

Among the 179 patients, emmetropia was the most commonly observed refractive status, present in 68 patients (38%). Low hyperopia and low myopia were also common, with 64 and 40, respectively. A limited number of patients had moderate/high myopia and moderate/high hyperopia; in detail, the prevalence was as follows: 5% of patients had moderate myopia, while 0.5% of patients suffered from high myopia; symmetrically, 5% were moderate to high hyperopia. From the data collected, a trend emerged for a low refractive error and symmetric refractive error in both eyes.

Contrasted to prior conventional wisdom about refractive error in strabismus, it established the greater prevalence of emmetropia in patients with IXE. The findings call for specific management strategies to be applied in this population.