Strabismus in Children with Cataracts

Abstract

The presence of a pediatric cataract in a visually immature child may interfere with the development of binocularity and the maintenance of orthophoria [1–12]. A number of factors related to pediatric lens anomaly have been suggested to interrupt motor and sensory ocular alignment. These include suppression by the cataract, associated ocular anomalies, aggressive occlusive regimens and the presence of anisometropia and aniseikonia. Approximately 50 % of children with cataract will develop strabismus ([9], Hiles et al. 1977). It can occur with varying severity of bilateral and unilateral lens opacities but appears more common in the latter. Younger age at the onset of cataract and denser opacity correlates to a higher risk of strabismus. Thus presence of strabismus is seen as indicator that pediatric cataract had an early onset, is long standing, and/or is associated with amblyopia. To the contrary, patients with older age, partial cataract and better preoperative visual acuity are more likely to be orthophoric. Timely management of visually significant lens opacities is important for ocular alignment outcomes. Despite appropriate management of cataract, strabismus may develop after cataract surgery, irrespective of refractive and amblyopia rehabilitation.