Epidemiology of Pediatric Strabismus

Recognition and diagnosis of the individual forms of childhood strabismus are important for the best preservation of visual function. Esotropia is the most common form of pediatric ocular deviation in the West, whereas exotropia predominates in the East. Accommodative esotropia is the most prevalent form of strabismus in the West, comprising half of all esodeviations. Congenital, or infantile, esotropia accounts for less than 10% of all pediatric esotropia, a figure much smaller than once widely believed. Intermittent exotropia is the second most common form of childhood strabismus in the West and the most commonly diagnosed form of exodeviation worldwide. Hyperdeviations are uncommon, with fourth cranial nerve palsy being the most prevalent etiology. Major independent risk factors associated with strabismus development include: prematurity, central nervous system (CNS) impairment, low birth weight, family history, and refractive error. Recent studies have reported a decline in the number of surgeries performed for strabismus; however, population-based data of congenital esotropia in the United States confirms a more stable rate.