Don’t be lulled into a false sense of security when you see pseudostrabismus. Researchers recently found that young children diagnosed with the condition are at increased risk of developing strabismus and subsequently undergoing surgery.

This retrospective cohort study looked at 17,885 children who were diagnosed with pseudostrabismus when they were younger than four years old and later diagnosed with strabismus. The team assessed age, refractive error and amblyopia, and compared the participants with 7,787,743 controls diagnosed with esotropia, exotropia or unspecified heterotropia who had not been previously diagnosed with pseudostrabismus.

They discovered that strabismus was diagnosed in 9.6% of children initially diagnosed with pseudostrabismus at a median age of 1.65 years compared with 1.7% of children in the control group, with 21.9% undergoing strabismus surgery compared with 12.1% of the controls. They noted that strabismus was diagnosed more than a year later in the pseudostrabismus group (3.32 years) compared with the control group (2.28 years). The investigators added that esotropia was the most common type of strabismus in both groups (pseudostrabismus, 69.7%; control, 62.1%).

Ryu WY, Lambert SR. Incidence of strabismus and amblyopia among children initially diagnosed with pseudostrabismus using the Optum dataset. Am J Ophthalmol. November 13, 2019. [Epub ahead of print].