Neonatal ocular misalignments rarely become esotropia

Horwood A. Br J Ophthalmol 2003;87 1146-1150

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• Neonatal ocular misalignments are common and rarely a sign of developing infantile esotropia
• In normal babies they should be INTERMITTENT, IMPROVING BY TWO MONTHS and GONE BY FOUR MONTHS

Background

214 orthoptists’ infants have been followed for up to 15 years, relating neonatal misalignment (NMs) behaviour to onset of convergence and 20 Delta base out prism response, and also to later childhood ocular abnormalities.

Methods

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.

Results

Results confirm previously reported characteristics of NMs. Infants who were misaligned more frequently were misaligned for longer periods (p <0.01) and were later to achieve constant alignment (p <0.001) but were earlier to attempt first convergence (p = 0.03). Maximum NM frequency was usually found at or before the onset of first convergence (p = 0.0002).

Conclusions

NMs occur in the first 2 months of life and usually reflect a normally developing vergence system. They appear to represent early attempts at convergence to near targets. Emerging infantile esotropia is indistinguishable from frequent NMs before 2 months.