Paralytic Strabismus in South African Black and Mixed Race Children – A 15-year Clinic-based Review

Abstract

Purpose: To describe the demographics and clinical profile of paralytic strabismus in South African black and mixed race children seen at a tertiary pediatric eye clinic.Methods: A retrospective, descriptive case series of patients younger than 14 years diagnosed with paralytic strabismus at the Red Cross War Memorial Children’s Hospital in Cape Town, between 1996 and 2010.Results: A total of 166 children were studied. Of these, 74% were of mixed race descent while 26% were black. The most commonly affected cranial nerve was the fourth (52%). The sixth nerve was involved in 39% of cases, while 5% and 4% had third nerve palsy and multiple cranial palsies, respectively. The majority of mixed race children (58%) had fourth cranial nerve palsies, while 54% of black children had sixth nerve palsies. The most common cause of paralytic strabismus was congenital (55%), followed by trauma (18%).Conclusion: In this clinic-based study, paralytic strabismus was more common in mixed race children. Fourth nerve palsies predominated in mixed race children, whereas the majority of black children had sixth nerve palsies. Further population-based research is necessary to identify the determinants of ocular cranial nerve palsy in African children.