Strabismus and binocular function in children with Down syndrome. A population‐based, longitudinal study

PURPOSE: We have performed a population-based, longitudinal study on strabismus in children with Down syndrome. The aims of the study were to examine the frequency and type of strabismus, the age at onset, and the binocular potential. METHODS: An unselected population of 60 children with Down syndrome born 1988-1999 was followed with repeated examinations. Mean follow-up time was 55+/-23 months (range 24--115). The alignment of the eyes was examined using Hirschberg corneal reflex test and cover test for near fixation. To evaluate binocular function, Titmus House Fly Test and Lang's stereo test were used. RESULTS: Twenty-five patients (42%) had strabismus (21 esotropias, two exodeviations and two vertical deviations). Only one case of infantile esotropia was found, the other esotropias were acquired forms. The mean age at "onset" (e.g. when strabismus was first noticed) was 54+/-35 months. In the acquired esotropia group (n=20), 15 (75%) were associated with hypermetropia (mean spherical equivalent +4.3+/-1.7 D). Seventeen of the strabismic patients had an accommodation weakness. Eleven of the strabismus patients gave a clearly positive response to one or both stereotests. CONCLUSIONS: The majority of the Down syndrome children with strabismus have an acquired esotropia and hence a potential for binocularity. Hypermetropia and accommodation weakness are probably important factors in esotropia in Down syndrome patients.