Development of Strabismus in Children Initially Diagnosed with Pseudostrabismus

Halil Pasha's legacy as a Turkish painter: Esotropia or pseudoesotropia in "Yaşlı Halayık"

Introduction: Esotropia is a form of strabismus, a condition characterized by the misalignment of the eyes. Specifically, esotropia refers to inward deviation of one or both eyes. It can manifest at different ages, ranging from infancy to adulthood, and can have varying degrees of severity. The false appearance of esotropia in the alignment of the visual axes is what defines pseudoesotropia. Halil Pasha was a Turkish painter known for his contributions to the art scene during the late 19th and early 20th centuries. His artistic talent, coupled with his influential position as a statesman, allowed him to leave a lasting impact on the cultural landscape of the Ottoman Empire. Methods: In the present study, artistic depictions of esotropia or pseudoesotropia in Halil Pasha's "Yaşlı Halayık" were evaluated. A comprehensive literature review on strabismus in medicine and art was conducted. Results: "Yaşlı Halayık", translated as "Old Servant Woman", is one of the iconic paintings of Turkish art. It reflects the social dynamics and lifestyle of the time, offering a glimpse into the lives of women serving in Ottoman households. When we examine this painting as a physician, the first thing we notice is the old woman's eyes. An eye misalignment in the left eye of the old servant woman is noticed. Discussion: In medical humanities, which are addressed in medical education, medicine and art intersect with different perspectives and understandings. Although the evaluation of medical scenes in artworks seems to have been first observed by an art historian, today physicians and medical students need to examine artworks more carefully and develop their observational skills. Iconodiagnosis is the medical analysis of artworks that looks for clinical signs suggestive of medical disorders and diseases. The application of iconodiagnosis in medical education is an alternative and stimulating way to exercise students' observation skills; not only the physical examination of the patient is important, but also the information obtained from their posture, clothing, general demeanour and even physical aids.

Screening, Diagnosis, and Treatment of Pediatric Ocular Diseases

Vision is an important aspect of a child's quality of life and intellectual, social, and emotional development. Disruptions to vision during infancy and early childhood can cause lifelong vision impairment or blindness. However, early identification and treatment of eye disease can prevent loss of sight and its consequent long-term effects. Therefore, screening guidelines exist to guide physicians in detecting the most common threats to sight in the different stages of infancy and childhood. This review describes common causes of pediatric vision impairment, the recommended screening guidelines for diagnosing them, and current treatment modalities.

Presence and development of strabismus in children with telecanthus, epicanthus and hypertelorism

Purpose

To study the presence and development of strabismus in children with telecanthus, epicanthus, and hypertelorism.

Methods

This is a prospective, longitudinal, and observational study. Sixty children aged between 6 months and 18 years with telecanthus, epicanthus, and hypertelorism in isolation or in combination were recruited. A detailed analysis of the history, determination of best corrected visual acuity, complete evaluation of strabismus, and ocular examination were carried out. The presence of telecanthus, epicanthus, and hypertelorism and associated strabismus, if any, was noted. All children were followed up for a minimum and maximum period of 12 and 18 months, respectively, to analyze the strabismus (previously present) and for detection of strabismus in those who did not have. The data were analyzed descriptively with mean and standard deviation. Chi square test and Fishers exact test were used to analyze the data between the groups. A P value less than 0.05 was considered to be statistically significant.

Results

Telecanthus was the most common lid feature (55%). At baseline, ten (16.66%) children had strabismus (six: esotropia; four: exotropia). Two (3.33%) children underwent surgery. One child developed exotropia at the third follow-up (18 months). At the end of the study, 11 (18.33%) children had strabismus. No significant association was seen between lid characteristics and the type of strabismus.

Conclusion

Children with telecanthus, epicanthus, and hypertelorism in isolation or in combination may or may not have associated strabismus. These features can pose difficulty in strabismus diagnosis, which mandates a careful examination, especially in younger age groups and small-angle strabismus. On the other hand, children without strabismus need longer follow-up to detect the development of strabismus and to initiate further management at the earliest.

Pseudostrabismus in the First Year of Life and the Subsequent Diagnosis of Strabismus

PURPOSE

To report the population-based birth prevalence of pseudostrabismus in the first year of life and the subsequent diagnosis of strabismus.

DESIGN

Retrospective population-based cohort study.

METHODS

All residents of Olmsted County, Minnesota ≤1 year old diagnosed with pseudostrabismus from January 1, 2005 through December 31, 2014, were identified using a medical record linkage system that captures virtually all medical care provided in a single Midwestern United States county population. The birth prevalence of pseudostrabismus and the subsequent diagnosis of strabismus were assessed.

RESULTS

A total of 184 infants were diagnosed with pseudostrabismus during the 10-year study period, which yielded a birth prevalence of 1 in 113 children in the first year of life. There were 165 (89.7%) infants initially diagnosed by a non-ophthalmology care provider (NOCP) and confirmed by an ophthalmologist, 13 (7.1%) patients were diagnosed by an ophthalmologist alone, and 6 (3.3%) patients were diagnosed by a NOCP alone. Eighty-eight (49.4%) infants had at least 1 follow-up visit with an ophthalmologist, and the median follow-up time from pseudostrabismus diagnosis to the last health care visit that included an eye examination was 7.7 years (interquartile range: 5.8 years). Nine (4.9%) of the 184 infants were subsequently diagnosed with strabismus at a mean age of 4.5 years (range: 1.3 to 8.7 years) (7 with esotropia and 2 with exotropia).

CONCLUSION

Pseudostrabismus is a relatively frequent diagnosis in the first year of life. The prevalence of strabismus among infants with pseudostrabismus in this cohort was lower than those in previous reports and similar to strabismus rates reported in the same population.

Incidence of Strabismus and Amblyopia Among Children Initially Diagnosed With Pseudostrabismus Using the Optum Data Set

PURPOSE

To determine the frequency of strabismus among children initially diagnosed with pseudostrabismus using big data.

DESIGN

Population-based retrospective cohort study.

METHODS

Setting: Population-based retrospective cohort study using claims data. StudyPopulation: 17,885 children diagnosed with pseudostrabismus at age ≤3 years who were later diagnosed with strabismus using the Optum deidentified Clinformatics Data Mart Database (2003-2016). We excluded patients diagnosed with strabismus before the diagnosis of pseudostrabismus or diagnosed simultaneously with strabismus and pseudostrabismus.

OBSERVATIONS

We assessed age, refractive error, and presence of amblyopia. Patients with pseudostrabismus were compared to a group of patients from the Optum data set diagnosed with esotropia, exotropia, and unspecified heterotropia who had not been previously diagnosed with pseudostrabismus. MainOutcomeMeasures: Incidence of strabismus, among patients initially diagnosed with pseudostrabismus vs those without an initial diagnosis of pseudostrabismus.

RESULTS

Strabismus was diagnosed in 9.6% (n = 1,725) of children initially diagnosed with pseudostrabismus at a median age of 1.65 years (IQR: 1.17-2.46) compared to 1.7% (136,047 of 7,787,743) of children in the control group (P < .001). Strabismus was diagnosed more than a year later in the pseudostrabismus group (3.32 years; IQR: 2.28-4.74) compared with the control group (2.28 years, IQR: 1.43-3.16) (P < .001). Esotropia was the most common type of strabismus in both groups (pseudostrabismus, 69.7%; control, 62.1%). A total of 377 children (21.9%) in the pseudostrabismus group underwent strabismus surgery compared with 12.1% of children in the control group (P < .001).

CONCLUSIONS

Young children diagnosed with pseudostrabismus are at increased risk of developing strabismus and undergoing strabismus surgery.