Prevalence of systemic and ocular disease in infantile exotropia - Comparison with infantile esotropia

Objective: Exotropia in infancy is believed to be associated with an increa sed prevalence of neurologic, ocular, and craniofacial abnormalities; howev er, the prevalence of coexisting ocular and systemic disease in these patie nts is unknown. In this study, the prevalence of ocular disease and systemi c illness was determined in patients diagnosed with exotropia in infancy. Design: Observational comparative case series. Participants: Medical records of 70 patients diagnosed with exotropia in th e first year of life were reviewed and compared with records of 136 patient s diagnosed with esotropia before 1 year of age. Intervention: Patients with no disorders (other than latent nystagmus, diss ociated vertical deviation, or oblique muscle overaction) were grouped as " simple" strabismus. Patients with systemic disorders (including prematurity , neurologic disease, and genetic disease) and patients with ocular disorde rs (including congenital nystagmus, other strabismus, ptosis, and any condi tion associated with loss of vision [except amblyopia]) were grouped as "co mplex" strabismus. Main Outcome Measures: Prevalence of coexisting systemic and ocular disorde rs. The demographics, strabismus measurements, and types of coexisting dise ase in the simple and complex groups were compared. Results: A high percentage of both exotropia (67%) and esotropia (49%) pati ents had a coexisting ocular or systemic abnormality. Exotropia patients wi th a constant strabismus were more likely to have coexisting ocular or syst emic disease than those with an intermittent strabismus. Smaller angles of exotropia or esotropia were associated with a higher likelihood of coexisti ng ocular or systemic diseases. Systemic disorders were found more frequent ly than ocular disorders in both the exotropia and esotropia groups. In 25% of all patients referred for evaluation of strabismus, an additional ocula r or systemic abnormality was discovered by the ophthalmologist. Conclusion: Patients presenting to a university hospital-based practice in the first year of life with exotropia were more likely than those presentin g with esotropia to have coexisting ocular and systemic disease. Both group s had a notably high prevalence of associated disorders. The percentages me asured in this population may not be applicable to other practices because of referral bias, However, clinicians should consider that children present ing with infantile exotropia and esotropia appear to be at risk for coexist ing ocular or systemic disease.