DHEAS Exposure and Strabismus: No Established Causal Relationship
Based on the available evidence, there is no established causal relationship between Dehydroepiandrosterone sulfate (DHEAS) exposure and strabismus development.
Understanding DHEAS
DHEAS is an endogenous steroid hormone produced primarily by the adrenal glands. It serves as:
- The most reliable measure of adrenal androgen production 1
- A diagnostic marker for conditions like adrenal insufficiency 2
- A hormone that reaches maximum circulating concentrations between ages 20-30, followed by a gradual decline with age 1
Strabismus: Causes and Risk Factors
The Adult Strabismus Preferred Practice Pattern guidelines do not identify DHEAS or related hormones as causative factors for strabismus. Instead, established causes and risk factors include:
- Cranial nerve palsies
- Thyroid eye disease (most common identified risk factor for certain complications) 3
- High axial myopia
- Previous ocular surgery
- Restrictive disorders
- Neurological conditions
Thyroid Eye Disease and Strabismus
Thyroid eye disease is specifically identified as a significant cause of adult strabismus:
- Incidence of 16 per 100,000 per year in women and 2.9 per 100,000 per year in men 3
- Most often presents in the fourth to fifth decade of life 3
- Predilection among women (8:1) 3
- Can cause restrictive strabismus due to extraocular muscle involvement 3
DHEAS Clinical Applications and Side Effects
DHEAS is used clinically in specific scenarios:
- DHEA replacement (10-50 mg daily) for women with primary adrenal insufficiency experiencing persistent lack of libido and/or low energy 1
- Vaginal DHEA (prasterone) for treating vaginal dryness or pain with sexual activity in postmenopausal women 1
Known side effects of DHEA supplementation do not include ocular manifestations or strabismus:
- Long-term effects are not well established 1
- Caution is advised in patients with hormone-sensitive conditions 1
- Monitoring is required for potential hormone-dependent cancers 1
Evaluation of Strabismus
When evaluating strabismus, the Adult Strabismus Preferred Practice Pattern recommends:
- Assessment of alignment by light reflex testing 3
- Complete motility examination, including cover-uncover and alternate-cover testing 3
- Testing for binocular fusion and stereopsis 3
- Inspection for conjunctival scars and interpalpebral fissures 3
- Assessment for ocular torsion 3
None of these evaluations involve assessment of DHEAS levels or other hormonal factors, suggesting no established connection between DHEAS and strabismus.
Complications of Strabismus Surgery
Complications from strabismus surgery are well-documented but do not include any related to DHEAS:
- Common minor complications: foreign body sensation, corneal abrasion, allergic reaction 3
- Serious but rare complications: endophthalmitis, orbital cellulitis, retinal detachment 3
Conclusion
The current medical literature and clinical guidelines do not support a causal relationship between DHEAS exposure and strabismus. The established causes of strabismus are primarily mechanical, neurological, or related to specific conditions like thyroid eye disease, with no evidence linking adrenal steroid hormones to strabismus development.
If strabismus is present, evaluation and management should follow established guidelines focusing on the known etiologies rather than investigating DHEAS levels or exposure.