Incidence of strabismus and amblyopia in preverbal children previously diagnosed with pseudoesotropia

Purpose: To determine how frequently children diagnosed with pseudoesotropia before 3 years of age are later found to have true strabismus or amblyopia.

Methods: Records of all patients presenting to one pediatric ophthalmologist between January 1, 2001, and February 26, 2010, were reviewed retrospectively. Patients diagnosed with pseudoesotropia who had an otherwise normal examination were included.

Results: A total of 306 patients were diagnosed with pseudoesotropia with no significant refractive error on initial examination. Of these, 201 had the follow-up examination recommended for all 306 patients. The average age at the time of the initial examination was 13 months (range, 2-33). The average age at follow-up was 33 months (range, 4-120). Of the 201 patients, 20 were later found to have strabismus (10%) and 5 were later found to have significant refractive error and mild refractive amblyopia (2%). Of the 20 children found to have strabismus, 15 had esodeviation, 3 had exodeviation, 1 had Duane syndrome, and 1 had Prader-Willi syndrome with esotropia.

Conclusions: Of children initially diagnosed with pseudoesotropia under age 3 who returned for follow-up, 12% were later found to have strabismus or mild refractive amblyopia. The ultimate prevalence of strabismus or amblyopia was higher in children diagnosed with pseudoesotropia than would be expected in the general population.