Impact of horizontal strabismus on mental health among children and adults in China.

AIM: To evaluate the impact of strabismus on mental health among children and adults in China.

METHODS

This cross-sectional study assessed the mental health status of 49 children (aged 6-18 years) and 48 adults (aged 18-60 years) diagnosed with horizontal strabismus at Shenzhen Eye Hospital between December 2021 and February 2022. The Social Anxiety Scale for Children (SASC) was used for pediatric participants, the Chinese Adult Strabismus Quality of Life Scale (CAS-20) for adult participants, and the Symptom Checklist-90 (SCL-90) was used for all patients.

RESULTS

No significant correlations were observed between the angle of deviation and total or subscale scores on the SCL-90 (R = 0.100, p = 0.380). No statistically significant differences were found in SASC, CAS-20, or SCL-90 scores when comparing participants with exotropia versus esotropia, or between pediatric and adult cohorts. Univariate linear regression did not identify any significant independent variables for CAS-20 or SCL-90 scores. A linear relationship was identified between age and binocular fusion status and the total SASC score (r² = 0.223). Multiple linear regression indicated that the total SASC score increased by 0.581 per year of age (p = 0.025) and by 3.014 in the absence of binocular fusion (p = 0.025). Participants without binocular fusion demonstrated higher total SASC scores than those with fusion (p = 0.020), particularly in the "social avoidance and distress" domain (p = 0.002).

CONCLUSION

Horizontal strabismus significantly influences social anxiety in children, with age and binocular function identified as associated factors. Restoration of binocular function following strabismus surgery may be critical not only for preserving ocular alignment but also for supporting psychological well-being in pediatric populations.