Symptom based diagnosis of infant under one year in outpatient clinic

Pseudoesotropia in Chinese Children: A Triphasic Development of the Interepicanthal Folds Distance-to-Interpupillary Distance Ratio and Its Changing Perception

Purpose

To delineate the development of the interepicanthal fold distance (IEFD) to interpupillary distance (IPD) in Chinese children, and to quantify how their ratio (EFDPD ratio) affects parent’s judgment on whether a child’s two eyes appear misaligned.

Methods

The values of IPD and IEFD were measured in 750 children, aged between 3 and 17 years. The developmental trend of EFDPD ratio was established. Two hundred parents were shown a series of pictures of children with varying EFDPD ratios and asked to judge whether the child in each picture demonstrated misaligned eyes. Based on the parent’s responses, psychometric functional associations with EFDPD ratios were established.

Results

The EFDPD ratios were significantly higher (0.63 ± 0.027) and showed little change among children from 3 to 6 years of age (p = 0.704). During the age of seven to 12 years, however, the EFDPD ratio significantly decreased (p < 0.001) before stabilizing at 0.59 ± 0.023 by the ages of 13 to 17 years (p = 0.376). Children with EFDPD ratios > 0.65 were more likely to be perceived as strabismic by the parents, while children with an EFDPD ratio < 0.55 were rarely perceived as so. As many as 30% of the children aged between 3 and 6 years demonstrated EFDPD ratios > 0.65, and this number reduced to 5% by the age of 12 years.

Conclusions

The development of the EFDPD ratio in Chinese children shows a triphasic pattern, with a large value before the age of 6 years, a quick drop between 7 and 12 years, and little change after 13 years of age. As the EFDPD ratio declines, fewer children appear as strabismic.

Level of Evidence IV

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Infrared photographs with a selective wavelength filter to diagnose small-angle esotropia in young children

PURPOSE

To validate the effectiveness of the selective wavelength filter analysis with infrared photographs for diagnosing small-angle esotropia in children under age 4.

METHODS

This is a retrospective, observational, case-control study. A total of 83 esotropes with an esodeviation of ≤ 16 prism diopters (PD) and 75 orthotropic controls under 4 years of age were included. Full-face infrared photographs were taken with a selective wavelength filter in front of either eye. The angles of esodeviation on photographs were measured with the three-dimensional Strabismus Photo Analyzer. The alternate prism and cover test or the Krimsky test were repeatedly performed to measure ocular alignment.

RESULTS

The testability of infrared photographs using selective wavelength filters in children under 4 years of age was 85.6%. The mean angle of esodeviation was 11.3 ± 4.0 PD by manual measurements and 11.5 ± 4.4 PD by the infrared photograph analysis. Manual measurements and the infrared photograph analysis showed a strong positive correlation (R = 0.815, P < 0.001). The sensitivity and specificity of the infrared photograph analysis for detecting small-angle esotropia were 95.2% and 77.9%, respectively, with a cutoff value of 4.0 PD.

CONCLUSIONS

The automated infrared photograph analysis was simple and effective for diagnosing small-angle esotropia in young children.