Current concepts in the management of strabismus in children with cerebral palsy.

Few guidelines have been advanced for the management of brain damaged children with strabismus. Conservative therapy with lenses, prisms, occlusion, atropine and late surgery has been suggested but without specific methods or ages being advocated. The authors undertook the treatment of these children utilizing the standard principles of strabismus therapy as applied to neurologically normal children. A further consideration is a satisfactory cosmetic appearance which wins greater self, peer and parental acceptance in these handicapped children. The results of therapy of this series of patients with cerebral palsy indicates that satisfactory alignment can be achieved in the majority even in the presence of severe motor involvement and/or mental retardation. Ninety percent of those patients with treated accomodative esotropia achieved a satisfactory alignment. Those patients with non accommodative esotropia had a satisfactory alignment in 77% of the patients operated upon and those with exotropia achieved this result in 86% of the patients operated upon. Only five (2%) patients spontaneously reduced their angles to cosmetically acceptable ranges. Overcorrections occurred in 10 (11%) patients in the surgically treated nonaccommodative esotropes and 4 (3%) of these patients required further corrective surgery. Only one exotropic patient was rendered esotropic postoperatively. The average age of initial surgery in the esotropic patients was 3.9 years and 5.7 years in the exotropic patients. The older ages for surgical intervention reflects the more conservative approach to these neurologically abnormal children and allow an increased time interval for the development of a stable preoperative oculomotor alignment.