Anatomical and Physiological Determinants of Strabismus in Pakistani Children

Abstract

Background: Strabismus is a common pediatric ocular disorder characterized by misalignment of the eyes due to abnormalities in extraocular muscle coordination, neuromuscular control, and visual physiology. If left untreated, it may lead to amblyopia, impaired binocular vision, poor academic performance, and psychological distress in children. Anatomical, physiological, and systemic medical factors contribute significantly to the development and progression of pediatric strabismus. Early diagnosis and multidisciplinary management are therefore essential, particularly in Pakistan where pediatric ophthalmic screening remains limited.

Objective: To determine the anatomical and physiological basis of strabismus in Pakistani children and to evaluate its association with clinical and medical factors.

Methodology: This cross-sectional observational study was conducted in the Departments of Ophthalmology, at two tertiary care hospitals in Karachi and Lahore, Pakistan. A total of 120 children aged 2–15 years diagnosed with strabismus were included using non-probability consecutive sampling, 60 from each hospital respectively. Detailed ophthalmic examination including visual acuity assessment, Hirschberg test, cover–uncover test, ocular motility examination, cranial nerve assessment, and binocular vision testing was performed. Anatomical and physiological variables including extraocular muscle imbalance, refractive errors, neuromuscular dysfunction, orbital abnormalities, craniofacial anomalies, and associated systemic diseases were evaluated. Data were analyzed using SPSS version 26, and p < 0.05 was considered statistically significant.

Results: Among the 120 children studied, 68 (56.7%) were males and 52 (43.3%) were females, with a mean age of 7.9 ± 3.4 years. Esotropia was the most common type of strabismus observed in 64 (53.3%) children, followed by exotropia in 38 (31.7%) and vertical strabismus in 18 (15.0%) cases. Extraocular muscle imbalance was identified in 72 (60.0%) children, while refractive errors were present in 66 (55.0%) cases. Impaired binocular vision was observed in 58 (48.3%) participants, and associated neurological or systemic medical conditions were found in 29 (24.2%) children. A statistically significant association was observed between refractive errors and severity of strabismus (p = 0.01), as well as between neuromuscular dysfunction and impaired binocular vision (p = 0.03). Positive family history was reported in 34 (28.3%) children.

Conclusion: Pediatric strabismus in Pakistani children is strongly associated with anatomical abnormalities, altered visual physiology, and systemic medical factors. Esotropia and extraocular muscle imbalance were the predominant findings. Early multidisciplinary evaluation involving ophthalmology, physiology, pediatrics, and medicine may improve diagnosis, management, and prevention of long-term visual complications in children.