Boys with intermittent exotropia more likely to develop mental illness

Rochester, MN-Children with intermittent exotropia, especially boys, appear more likely to develop mental illness by young adulthood than children without strabismus, according to a report in the June issue of Archives of Ophthalmology.

"Intermittent exotropia occurs in approximately 1% of developmentally healthy children in the United States and, given its predominance over esodeviations [when the eye turns in] among Asian populations, it may be the most prevalent form of strabismus worldwide," the authors wrote.

Researchers analyzed the medical records of 183 children younger than 19 in Olmsted County, MN, whose intermittent extropia was diagnosed between 1975 and 1994. For each patient there was one control child who was the same age but did not have a diagnosis of any type of strabismus. Both groups were followed to an average age of 22 years.

During the study, 97 (53%) children with intermittent extropia were diagnosed with a mental health disorder, compared with 55 controls (30.1%). Mental health disorders were diagnosed in 63% of boys (41of 65) and 47% of girls (56 of 118) with intermittent extropia, compared with 33% of boys (22 of 66) and 28% of girls (33 of 117) in the control group.

"Studies regarding the psychosocial impact of strabismus have reported that individuals with intermittent exotropia are not judged more poorly than individuals with orthotropia [the absence of strabismus] by adult observers. However, a negative bias toward people with strabismus has been demonstrated in children," the authors wrote. "Although this study focused on mental illness that was diagnosed by early adulthood, there is also evidence to suggest that the social problems associated with strabismus persist and even intensify into adult life."

"Further study is needed to determine whether interventions for intermittent exotropia can decrease or otherwise alter the future development of mental illness," authors concluded.