The Prevalence and Association of Refractive Errors in Pediatric Strabismus: A Prospective Observational Study

Background: Strabismus, or misalignment of the eyes, is a common pediatric condition that affects visual development and quality of life. Refractive errors such as myopia, hyperopia, and astigmatism are believed to contribute to strabismus. Early identification and treatment of these errors may help reduce the severity of strabismus. However, there is limited research on the prevalence of refractive errors in pediatric strabismus cases in South Gujarat, India, highlighting the need for further investigation.

Purpose: This study aims to determine the prevalence of refractive errors among pediatric patients with strabismus and explore the relationship between specific refractive errors and different types of strabismus (esotropia and exotropia) in a tertiary care center in South Gujarat, India.

Materials and Methods: A prospective, observational study was conducted from August 2023 to July 2024, involving 78 pediatric strabismus patients out of 1044 children at a tertiary care center in Surat. Data on refractive status (myopia, hyperopia, astigmatism) and strabismus type (esotropia, exotropia) were collected using vision charts, retinoscopy, autorefractometers, a trial lens set, prism bars, and occluders. Statistical analysis, including chi-square tests, assessed the association between refractive errors and strabismus types (p < 0.05).

Results: Among 1044 children, 78 patients (7.47%) were strabismic, out of which 86% had ametropia, while 14% were emmetropic. Hyperopia was strongly associated with esotropia (36.54%), whereas myopic astigmatism (28.84%) and astigmatism (23.72%) were linked to exotropia. Amblyopia was diagnosed in 26.92% of strabismic patients, with higher prevalence in exotropia cases. A significant association between refractive errors and strabismus was found (p < 0.0001).

Conclusion: The study highlights a strong link between refractive errors and strabismus, particularly hyperopia with esotropia and myopia/astigmatism with exotropia. Early detection of refractive errors could prevent or lessen strabismus, and further research with larger samples is recommended.

  Keywords: Strabismus, Refractive errors, Pediatric, Esotropia, Exotropia, Amblyopia, Hyperopia, Myopia, Astigmatism