THE PREVALENCE OF NEUROLOGIC DYSFUNCTION IN CHILDREN WITH STRABISMUS WHO HAVE SUPERIOR OBLIQUE OVERACTION

Background. Children with certain neurologic diseases (hydrocephalus, meningo-myelocele, or cerebral palsy) have been reported to manifest a high frequency of A-pattern strabismus and superior oblique overactio n. However, it is not generally recognized whether children with strab ismus who have superior oblique overaction are more likely to have con current neurologic diseases than those without superior oblique overac tion. In this study, the authors examine this issue. Methods: The auth ors retrospectively reviewed the medical records of all patients (n = 168) with overdepression of the downturned eye in adduction, who were examined between October 1989 and March 1992. A randomly selected popu lation of children with strabismus who did not have overdepression of the eye on infraduction and adduction served as controls (n = 98). Pat ients with simulating or confounding conditions such as pseudo-superio r oblique overaction, inferior rectus skew deviation (alternating skew on lateral gaze), and restrictive or paralytic strabismus, and who we re older than 20 years of age, were excluded. Results: One hundred twe lve patients with true superior oblique overaction were analyzed. Of t hese 112 patients, 45 (40.2%) had concurrent neurologic abnormalities, compared with less than one fifth (17.3%) of control subjects (17 of 98) (P less-than-or-equal-to 0.001). Conclusions: Children with strabi smus who have superior oblique overaction were found to have higher pr evalence of concurrent neurologic diseases than control subjects. Supe rior oblique overaction may represent a clinical marker for an associa ted neurologic dysfunction, possibly representing a form of skew devia tion in some cases.