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Outcome of Surgery for Esotropia in Children with Down Syndrome

Correspondence: Requests for reprints should be addressed to: Mark S. Ruttum, M.D., Eye Institute, 925 N. 87^th St., Milwaukee, WI 53226-4812.

Background and Purpose: The outcome of surgery for esotropia in children with Down syndrome has not received significant attention.

Patients and Methods: We reviewed motor outcomes of esotropia surgery in all patients with Down syndrome in our practice from 1991–2001.

Results: Twenty-one patients had surgery for esotropia. The mean age at surgery was 55 months. The mean preoperative esotropia was 36. Three patients required a second surgery: two for residual esotropia and one for consecutive exotropia. A second operation was recommended for two additional patients: one with residual esotropia and one with consecutive exotropia. The mean length of follow-up was 39 months. At the last follow-up examination, fourteen patients had a deviation of 0–10 (thirteen esotropic and one exotropic). Five patients had a final deviation of 11–20 (four esotropic and one exotropic). One patient had a residual esotropia of 21–30 and one had greater than 30 of residual esotropia.

Conclusion: The motor outcomes for esotropia surgery in children with Down syndrome were not as good as those in children with acquired esotropia but were comparable to those in children with infantile esotropia. More children had residual esotropia than consecutive exotropia, which may reflect a tendency toward conservative amounts of surgery or an underlying esotropic tendency in Down syndrome. Parents of children with Down syndrome may be counseled to expect good outcomes in the surgical management of esotropia.

Key words: strabismus surgery, esotropia, Down syndrome