Too much or too little: neonatal ocular misalignments predict later abnormalities

Horwood A. Br J Ophthalmol 2003;87 1142-1145

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  • Occasional ocular misalignments seem typical of normal visual development. Frequently, but also never, showing such misalignments carries increased risk of later strabismus and refractive error.


214 orthoptists’ infants have been followed for up to 15 years, relating neonatal misalignment (NMs) and first convergence onset to later childhood ocular abnormalities. NMs are shown in a companion paper to reflect the onset of first convergence, but if frequent or absent may predict a higher risk of refractive error and esodeviation.


In a prospective postal survey, orthoptist mothers observed their own infants during the first months of life and regularly reported ocular behaviour and alignment, visual development, and any subsequent ocular abnormalities.


Later strabismus and refractive error were less common in infants who showed NMs occasionally compared with those who never or frequently did. There was a significant linear trend for fewer ocular abnormalities to be found in children with more frequent NMs (p<0.001). Hypermetropes were later to show first convergence than emmetropes or myopes (p = 0.006)


NMs usually reflect an emerging and normally developing vergence system. This study suggests that delayed onset of convergence (and lack of NMs) is associated with later defects, especially hyperopia. Possible causal relations are discussed.