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Distribution of refractive errors and horizontal concomitant strabismus in Iraqi children
Hassan A Aljaberi1,2, Saeed Rahmani2, Humam H Alrikabi2
1Optical Techniques Department, College of Health and Medical Techniques, Al-Mustaqbal University, Babylon, Iraq.
Plos One
|May 27, 2026
Summary
In Iraqi children, esotropia is linked to hyperopia, while exotropia is associated with myopia and astigmatism. Early cycloplegic refraction is crucial for diagnosing ocular misalignment in pediatric patients.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Refractive Errors
Background:
- Horizontal concomitant strabismus is a prevalent pediatric eye condition.
- Refractive errors are known influences, but data from Iraq is scarce.
- Understanding these links is vital for early diagnosis and management.
Purpose of the Study:
- To characterize refractive profiles in pediatric esotropia and exotropia.
- To identify refractive predictors for each subtype of strabismus.
- To contribute evidence on strabismus and refractive errors in Iraqi children.
Main Methods:
- Retrospective analysis of 2,256 children (aged 4-15) from three Iraqi pediatric ophthalmology centers.
- 1,012 children with horizontal concomitant strabismus (esotropia/exotropia) and 1,244 controls were included.
- Standardized cycloplegic refraction, visual acuity, and ocular alignment tests were performed.
Main Results:
- Esotropia cases were younger with a hyperopic profile (78% ≥ +2.00 D SE).
- Exotropia cases were slightly older, associated with myopia (53.5%) and astigmatism (≥1.00 D in 55.7%).
- Moderate-to-high hyperopia predicted esotropia; myopia and significant astigmatism predicted exotropia.
Conclusions:
- Contrasting refractive profiles exist between esotropia and exotropia in Iraqi children.
- Refractive error patterns significantly predict strabismus subtypes.
- Early cycloplegic refraction is essential for evaluating pediatric ocular misalignment.
