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Ariel Silbert, Noelle S. Matta, David I. Silbert; Incidence of Strabismus and Amblyopia in Preverbal Children Previously Diagnosed with Pseudoesotropia. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1603.
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To determine whether children diagnosed with pseudoesotropia prior to age 3 are later found to have true strabismus or amblyopia.
A retrospective chart review was conducted on all patients presenting to our pediatric ophthalmology clinic between January 1, 2001, and February 26, 2010. Patients were included in the analysis if they were designated with a CPT code of esotropia.
309 patients were diagnosed with pseudoesotropia, defined as normal alignment, measured by the pediatric ophthalmologist and/or orthoptist, and no significant refractive error on initial exam. All children had been advised to have a follow-up exam, but only 204 children did. The average age children were first seen was 13 months (2 - 33), average age of follow-up was 33 months (4 - 120). 20 children were later found to have strabismus (10%) and additionally 9 children had significant refractive error (4%). Of the 20 children found to have strabismus, 14 had esodeviation, 3 had exodeviation, and one child had Duane syndrome.
In our cohort, 14% of children under age 3 initially diagnosed with pseudoesotropia were later found to have strabismus or high refractive error. In contrast to what one might expect, the incidence of eventual strabismus or amblyopia was higher in children diagnosed with pseudoesotropia. Preverbal children diagnosed with pseudoesotropia should have a follow-up exam to firmly rule out amblyopia, as a negative examination cannot firmly rule out pathology, and may lead to a false sense of security.
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