This article is more than 5 years old. Information may no longer be current.
Study: Children with exotropia had higher chance of developing psychiatric disorders
Pediatrics. 2008:122(5):1033-1038.
Click Here to Manage Email Alerts
Psychiatric disorders developed by early adulthood more often in children with exotropia than in control subjects, a study found. However, children with esotropia were no more likely than control subjects to develop mental illness.
The population-based, nested-control study focused on 407 strabismus patients younger than 19 years of age living in Olmsted County, Minn., between Jan. 1, 1985, and Dec. 31, 1994; 266 of the children had esotropia and 141 had exotropia. Medical records were retrospectively reviewed for a diagnosis of psychiatric disease.
A mental health disorder was diagnosed in 168 patients (41.3%) with a history of childhood strabismus, who were monitored to a mean age of 17.4 years; 125 control subjects (30.7%) were diagnosed with a mental health disorder. Those with exotropia were 3.1 times more likely than control subjects to have a diagnosis of a psychiatric disorder when monitored to a mean age of 20.3 years.
Major depression and dysthymia were more common in strabismus patients than in control subjects. Depression (not otherwise specified) and attention-deficit hyperactivity disorder were the most prevalent diagnoses among all patients and controls.
The study was limited by several factors, including a racially homogeneous population in one geographic area, the rarity of some forms of strabismus in the community studied and follow-up ending too soon to detect disorders that might develop later in life.
This article presents evidence that “children with exotropia had a threefold increased risk of developing mental illness by early adulthood compared with control subjects.” Included in these mental illnesses are depression, ADHD, adjustment disorder, drug use and alcoholism. Those patients with esotropia were “no more likely than control subjects to develop mental illness.” Their cohort was racially skewed with almost 96% being white, not a group consistent with the melting pot of America. In addition, the cohort size was small in the esotropic group, which can make statistical significance an issue. The authors also state that “heredity is a more likely basis for any association between exotropia and mental illness.” Based on the data presented, it would be a prudent suggestion for the authors to lead the way for further study of this issue on a national basis so that the results reached can be more conclusive on this sensitive yet important subject. Once that occurs, I would consider discussing the updated study results with the parents in my practice.
− Robert S. Gold, MD
OSN Pediatrics/Strabismus Section Editor