A longitudinal study of children with a family history of strabismus: factors determining the incidence of strabismus.

A longitudinal study of ocular refraction, position, and fixation was performed in children with a family history of strabismus. The children were examined at regular intervals between 3 months and 4 years of age, and the results are discussed in terms of changes in refraction between different ages and correlations between refraction and development of strabismus and amblyopia. Six of 34 children (17.6%) developed constant or intermittent esotropia. The strabismus was first noted between 18 and 30 months of age except in one case. All esotropic children were 4 dioptres hypermetropic or more at 6 months, and their hypermetropia remained almost unchanged through the years. Seven additional children were 4 dioptres or more hypermetropic at 6 months but did not develop a squint. In contrast to the squinting children the hypermetropia in these children changed towards emmetropia. This emmetropisation was most pronounced during the first 2 years of age. The implications of these results for an early diagnosis of strabismus amblyopia are discussed.