Different treatments for a squint (deviation of the eye) that occurs within the first six months of life

Elliott S, Shafiq A

Published Online:

August 10, 2011

Infantile esotropia can affect the vision in the eye, the ability to use the two eyes together (binocularity) and also be a cosmetic issue to the child/parents. Treatment includes surgical and non-surgical interventions to reduce the squint and to enhance/aid binocularity in children. This review looks at the various interventions and also the timing of such treatment. The review did not find any randomised trials that compared treatment to another treatment or to no treatment. A large, multi-centre, non-randomised trial found that children operated on earlier had better binocularity at age six compared to the late surgery group. This group had been operated on more frequently however and there was no significant difference in the angle of the squint after surgery in either group. This review does not resolve the controversy regarding the best type of surgery, the value of non-surgical interventions and the optimal timing of either type of intervention. It highlights a need for further research in this area.

Abstract (click to read)

Background:

Infantile esotropia (IE) is the inward deviation of the eye. Various aspects of the clinical management of IE are unclear; mainly, the most effective type of intervention and the age at intervention.

Objectives:

The objective of this review was to assess the effectiveness of various surgical and non-surgical interventions for IE and to determine the significance of age at treatment with respect to outcome.

Search strategy:

We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 3), MEDLINE (January 1950 to April 2011), EMBASE (January 1980 to April 2011), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to April 2011), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) and ClinicalTrials.gov (www.clinicaltrials.gov). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 6 April 2011. We manually searched the conference proceedings of the European Strabismological Association (ESA) (1975 to 1997, 1999 to 2002), International Strabismological Association (ISA) (1994) and American Academy of Paediatric Ophthalmology and Strabismus meeting (AAPOS) (1995 to 2003). Efforts were made to contact researchers who are active in the field for information about further published or unpublished studies.

Selection criteria:

We included randomised trials comparing any surgical or non-surgical intervention for infantile esotropia.

Data collection and analysis:

Each review author independently assessed study abstracts identified from the electronic and manual searches.

Main results:

No studies were found that met our selection criteria and therefore none were included for analysis.

Authors' conclusions:

The main body of literature on interventions for IE are either retrospective studies or prospective cohort studies. It has not been possible through this review to resolve the controversies regarding type of surgery, non-surgical intervention and age of intervention. There is clearly a need for good quality trials to be conducted in these areas to improve the evidence base for the management of IE.

This record should be cited as:

Elliott S, Shafiq A. Interventions for infantile esotropia. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD004917. DOI: 10.1002/14651858.CD004917.pub2

Assessed as up to date:

April 6, 2011

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Primary Review Group:

Eyes and Vision Group

Health topics:

Eyes & vision > Ocular motility disorders

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Different treatments for a squint (deviation of the eye) that occurs within the first six months of life

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