Does neonatal ocular misalignment predict later abnormality?

Abstract

Purpose. A longitudinal prospective study was carried out to ascertain the significance of neonatal ocular misalignments. Methods Pre-school vision screening and hospital records were examined to determine the visual outcome of 1150 infants classified into 'often' (< 15% of waking hours), 'occasionally' (<15%) or 'never' having an ocular misalignment (neonatal squint) in the first 8 weeks of life. χ2 and Fisher's exact tests and ANOVA were used to analyse the data. Results. When compared with infants who had squinted occasionally or never, frequent squinting in the neonatal period (which occurred in 7.7% of the subjects) was significantly associated with having been prescribed spectacles (p = 0.04), both for hypermetropia (p = 0.04) and for myopia (p = 0.05). Frequent squinters also had a higher incidence of significant esodeviation (p = 0.04) and were more likely to be > 21 days premature (p = 0.05). Small numbers of abnormalities made statistical analysis limited, but there were weak trends towards more myopic and oblique astigmatism in the 'never' group. The esotropias in the 'often' group were more frequently intermittent than those found in the other groups. Conclusions. Occasional squinting in the first 8 weeks of life appears to be normal neonatal behaviour. Frequent squinting trebles the chances of developing a significant esodeviation or refractive error severe enough to require spectacles before 5 years of age but incidence of abnormality still does not exceed 9%.