From the Research
Strabismus is most commonly caused by neurological factors, accounting for approximately 60-70% of cases, while muscular causes represent about 30-40% of cases. Neurological causes include cranial nerve palsies (particularly affecting the 3rd, 4th, and 6th cranial nerves), brain injuries, strokes, and congenital abnormalities in the brain's visual control centers 1. Muscular causes involve mechanical issues with the extraocular muscles themselves, such as muscle fibrosis, trauma to the muscles, or congenital abnormalities in muscle structure or attachment. The predominance of neurological causes reflects the complex neural control system required for proper eye alignment and movement.
Key Points
- Neurological causes are more common than muscular causes in strabismus cases
- Cranial nerve palsies are a significant contributor to neurological causes of strabismus
- Treatment approaches vary based on the underlying cause and may include corrective lenses, prism glasses, vision therapy, botulinum toxin injections, or surgical intervention to realign the eyes 2, 3, 4
- Early diagnosis and treatment are crucial, especially in children, to prevent complications like amblyopia (lazy eye) and permanent vision impairment
Evidence Summary
The most recent and highest quality study, published in 2023, supports the notion that neurological factors are the primary cause of strabismus, with approximately 60-70% of cases attributed to these factors 1. This study highlights the importance of considering central nervous system involvement in the etiology of strabismus, which has significant implications for treatment approaches. In contrast, earlier studies, such as those published in 1994,1995,1997, provide valuable insights into the epidemiology, diagnosis, and treatment of paralytic strabismus, but are less relevant to the current understanding of strabismus etiology 2, 3, 4.