Strabismus最新文献

{"title":"Brown syndrome with Marcus-Gunn jaw-winking phenomenon and ptosis: distinct entities or a part of the congenital cranial dysinnervation spectrum?","authors":"Vaishali Tomar, Mittali Khurana, Aakanksha Raghuvanshi, Aarushi Saini, Shivani Kumari, Padma Chorol, Swarna Nishu, Subhash Dadeya","doi":"10.1080/09273972.2025.2593518","DOIUrl":"10.1080/09273972.2025.2593518","url":null,"abstract":"<p><strong>Introduction: </strong>Brown syndrome involves restricted elevation in adduction due to superior oblique tendon anomalies. Marcus-Gunn jaw-winking Syndrome (MGJWS) is a congenital synkinesis between jaw movement and eyelid elevation. Their coexistence along with ptosis in the same eye is extremely rare.</p><p><strong>Methods: </strong>We report a case of an 8-year-old girl presenting with right eye motility restriction consistent with findings of Brown Syndrome along with MGJWS and ptosis.</p><p><strong>Results: </strong>The patient showed right hypotropia with limited elevation in adduction, consistent with Brown syndrome. Ptosis resolved with mouth opening or jaw movement, consistent with MGJWS.</p><p><strong>Discussion: </strong>This is the first pediatric report of Brown syndrome with ipsilateral MGJWS and ptosis. The combination of mechanical restriction and dysinnervation underscores the complexity of congenital cranial dysinnervation disorders and highlights the importance of thorough clinical evaluation.</p>","PeriodicalId":51700,"journal":{"name":"Strabismus","volume":" ","pages":"428-431"},"PeriodicalIF":0.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145597878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A prospective randomized pilot study comparing fibrin glue, buried suture knot and exposed suture knot techniques for conjunctival closure in bilateral symmetrical fornix approach squint surgery.","authors":"Nidhi B Agarwal, Jenil N Sheth, Hardik Nanavati, Supriya S Sharma, Mekhla Naik, Ritik Gupta","doi":"10.1080/09273972.2025.2612517","DOIUrl":"10.1080/09273972.2025.2612517","url":null,"abstract":"<p><strong>Purpose: </strong>This study compared fibrin glue (FG), buried suture knot (BSK), and exposed suture knot (ESK) for conjunctival closure in bilateral symmetrical squint surgery through fornix incision.</p><p><strong>Method: </strong>This study enrolled patients over 10-years age undergoing bilateral, symmetric strabismus surgery. Pre-operative anterior segment optical coherence tomography (ASOCT) and slit-lamp photography were performed on the pre-determined surgical quadrant. All the patients underwent strabismus surgery using a fornix incision. Eyes were randomized using a block design to one of the 3 conjunctival closure groups. Conjunctival closure time was recorded. Post-operative assessments were conducted at 1 day, 1 week, 2 weeks, and 6 weeks. These assessments included: patient-reported pain, foreign body sensation (FB), itching, watering. Clinical signs of conjunctival hyperemia, discharge, and chemosis were assessed using a standardized scale. ASOCT and slit-lamp photography of the surgical site were done at each post-operative visit. Conjunctival thickness was measured from ASOCT images. Statistical analysis was performed by SPSS 23.0 version. Variables with <i>p</i> value < 0.05 were considered as statistically significant.</p><p><strong>Results: </strong>A total of 30 eyes were randomized to FG, BSK, or ESK group. The FG group demonstrated significantly faster conjunctival closure time (37.2 ± 29.0 s) compared to BSK (171.6 ± 53.1 s) and ESK (148.7 ± 51.0 s) (<i>p</i> < .001). Patient-reported symptoms were similar across groups; however, FG showed significantly greater comfort than BSK at two-weeks (<i>p</i> = .030). Objectively, FG exhibited significantly less inflammation than ESK at one-week (<i>p</i> = .013) and BSK at two-weeks (<i>p</i> = .015). Both BSK and ESK eyes and not FG eyes showed a significant increase in conjunctival thickness at six-weeks when compared to their pre-operative thickness. The BSK group developed a significantly thicker conjunctiva at two-weeks compared to both FG (<i>p</i> = .033) and ESK (<i>p</i> = .022). Complications in the FG group included one eye each with wound gaping and bacterial surgical site infection, while the ESK group had one eye with Tenon-cyst.</p><p><strong>Conclusion: </strong>Long-term patient comfort was comparable across all closure methods following fornix incision strabismus surgery. FG significantly reduced surgical time and early objective inflammation, offering an efficiency advantage. Both BSK and ESK techniques showed no significant difference in postoperative outcome or long-term comfort.</p>","PeriodicalId":51700,"journal":{"name":"Strabismus","volume":" ","pages":"308-315"},"PeriodicalIF":0.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145901613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bibliometric and visual analysis of research hotspots and future prospects in the study of amblyopia.","authors":"Yining Wang, Hailin Chu, Xuyao Liu, Xiaochun Shi, Min Gao, Yongxia Ren","doi":"10.1080/09273972.2026.2617281","DOIUrl":"10.1080/09273972.2026.2617281","url":null,"abstract":"<p><p><i>Purpose</i>: To perform a bibliometric analysis in the field of amblyopia research to examine current global trends and future research hotspots and compare contributions from different countries, institutions, authors and journals. <i>Methods</i>: Literature related to amblyopia published from 1 January 2000, to 31 December 2024, was retrieved from the Web of Science Core Collection (WoSCC) database. The language of the included studies was limited to English, and the types of publications were articles and reviews. Visualization and bibliometric network analysis were performed using VOSviewer and CiteSpace. A cooperation network among countries, institutions, authors and journals was drawn. We conducted co-occurrence analysis on the keywords to identify the research hotspots. <i>Results</i>: A total of 4714 papers on amblyopia were identified from 2000 to 2024. In 2000, only 81 papers were published; however, by 2024, 292 papers had been published. Over the past 25 years, a total of 3618 universities or institutions in 94 countries or regions have published research papers related to amblyopia. The United States ranked first with 1607 papers, followed by China and England. McGill University published the most research papers on amblyopia, with 166 published papers, accounting for 3.5% of all publications on the subject. The top three journals contributing to this field were the Journal of Aapos, Investigative Ophthalmology & Visual Science and the Journal of Pediatric Ophthalmology & Strabismus. Binocular iPad games, ocular dominance plasticity and research on the visual cortex of the brain will become future research hotspots in this field. <i>Conclusion</i>: In this work, the publications were primarily from the United States and Europe.Plasticity of the visual cortex and the dominant eye has received attention from researchers in the field of amblyopia, and new technologies such as virtual reality technology have begun to be applied to treat amblyopia. This study reveals the hotspots and trends in this field through bibliometric analysis.</p>","PeriodicalId":51700,"journal":{"name":"Strabismus","volume":" ","pages":"362-376"},"PeriodicalIF":0.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146068436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical outcomes of patients with acute acquired comitant non-accommodative esotropia (AACE) with and without pre-operative prism adaptation test (PAT).","authors":"Jenil Sheth, Sakshi Lalwani, Ajinkya Deshmukh, Ramesh Kekunnaya","doi":"10.1080/09273972.2026.2639589","DOIUrl":"10.1080/09273972.2026.2639589","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the surgicaloutcomes of patients with acute acquired comitant non-accommodative esotropia(AACE) with and without pre-operative prism adaptation test (PAT).</p><p><strong>Methods: </strong>The records of patientsdiagnosed with AACE who underwent strabismus surgery between January 2018 andDecember 2020 were reviewed. Those who had pre-operative PAT performed by asingle surgeon and those who had surgery without PAT by another single surgeonwere included in the analysis. The surgical outcomes were compared between thetwo groups, and postoperative alignment within 8 PD was considered a surgicalsuccess.</p><p><strong>Results: </strong>Thirty-six patients were included in the study; 15 underwent a 30-minute PATpre-operatively. The mean age in the PAT and non-PAT groups was 16.6 ± 7.7 years and 12.3 ± 5.8 years, respectively, and was comparable (<i>p</i> = .06). The meanpre-operative esotropia (40 ± 8.5PD vs 40 ± 15.6, <i>p</i> = .7) and medial rectusrecession (5.31 ± 0.8 mm vs 5.45 ± 0.7 mm, <i>p</i> = .6) were similar in both groups (<i>p</i> < .05). The median postoperative follow-up duration was 8 months (IQR:9.75 months). Five of 15 (33%) were prism responders (angle of deviationincreased by 10 PD). The median change in esotropia at presentation andpost-PAT was 4.5 PD (IQR: 12.5 PD). Overall surgical success was similarbetween the groups (80% vs 81%; <i>p</i> = .9). Only one patient in the non-PAT groupexperienced postoperative diplopia.</p><p><strong>Conclusion: </strong>Surgical outcomes werecomparable, irrespective of the prism adaptation test. The prism adaptationtest did not reveal consistently higher target angles; hence, for comparabledeviation, the medial rectus recession and surgical outcomes did not differ, irrespective of whether PAT was performed pre-operatively.</p>","PeriodicalId":51700,"journal":{"name":"Strabismus","volume":" ","pages":"341-346"},"PeriodicalIF":0.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147349830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preliminary application of virtual reality technology in binocular vision recovery of children with intermittent exotropia after surgery.","authors":"Wenquan Tang, Bin He, Yulin Luo","doi":"10.1080/09273972.2026.2638475","DOIUrl":"10.1080/09273972.2026.2638475","url":null,"abstract":"<p><p><i>Purpose</i>: To investigate the clinical effects ofvirtual reality (VR) technology in children with intermittent exotropia (IXT) after surgery and analyze the factorsinfluencing binocular vision recovery. <i>Methods</i>: In this retrospective study, 142 childrenwith IXT were divided into two groups according to whether they underwent VR training or conventional training after surgery. Controlgroup: 66 cases underwent conventional training (lens sequencing training, flipper training, polarized stereogram, andcheiroscope training). VR group: 76 patients underwent regular VR visualtraining. We evaluated preoperative and postoperative binocular vision (simultaneousperception, fusion, and stereopsis) and compared the binocular vision recoveryrates between the two groups. Logistic regression analysis was used to analyzethe factors influencing recovery of distance stereopsis. <i>Result</i>: Among the 142 children with IXT, we could not detect any significant differences in the simultaneous perceptionand near stereopsis recovery rates between the two groups preoperativelyand postoperatively. The fusion recovery rate in the VR group (85.5%) washigher than that in the control group (69.7%) (χ² = 5.187; <i>P</i>  < 0.05). The distance stereopsis recovery rate in the VR group (65.2%) was higherthan that in the control group (40.9%) (χ² = 7.786; <i>P</i>  < 0.05). The simultaneous perception, fusion, and stereopsis recovery rates at 3 and 6 monthspostoperatively were greater than those preoperatively in both the groups. Logisticregression analysis showed that age at onset (odds ratio(OR)=1.826, <i>p</i> < .05), age at surgery (OR = 0.840, <i>p</i> < .05), preoperation deviation (OR = 1.067, <i>p</i> < .05) and 6 months postoperation deviation (OR = 0.750, <i>p</i> < .05) were riskfactors that affected distance stereopsis recovery in children with IXT. <i>Conclusion</i>: VR technology can be used as a new trainingtool to promote simultaneous perception, fusion, and stereopsis recovery in IXTafter surgery. The age at onset and deviation at 6 months postoperatively wererisk factors that affected the recovery of distant stereopsis.</p>","PeriodicalId":51700,"journal":{"name":"Strabismus","volume":" ","pages":"334-340"},"PeriodicalIF":0.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of therapeutic prism treatment on ocular motor cranial nerve palsies among Moroccan patients.","authors":"Hossaibi Said, Jaouhari Mustapha, El Harrak Chaimae, Adil Hadri, Youssef El Merabet, Moulay Laarbi Ouahidi","doi":"10.1080/09273972.2025.2586127","DOIUrl":"10.1080/09273972.2025.2586127","url":null,"abstract":"<p><strong>Purpose: </strong>This study evaluates the effectiveness of prism therapy in patients with ocular motor palsies affecting the oculomotor (nerve III), abducens (nerve VI), and trochlear (nerve IV) nerves, focusing on four key criteria: deviation, diplopia, head posture, and ptosis.</p><p><strong>Methods: </strong>A comparative analysis was conducted on patients diagnosed with nerve III, nerve VI, or nerve IV palsy. Deviation measurements, diplopia occurrence, head posture abnormalities, and ptosis presence were assessed before and after prism therapy. Statistical analysis was performed to determine significant changes within each group and to compare outcomes across the three palsy types.</p><p><strong>Results: </strong>Therapeutic prism use resulted in significant improvements in ocular deviation and diplopia across all groups (<i>p</i> < .05). Mean deviation decreased from 22Δ to 12Δ in third nerve palsy, from 38Δ to 14Δ in sixth nerve palsy, and from 18Δ to 8Δ in fourth nerve palsy. Diplopia in primary gaze was reduced from over 80% to below 21% across all groups. Although cyclodeviation was observed only in 29% of fourth nerve palsy cases, 71% of those patients reported subjective improvement. No statistically significant differences were found between the groups regarding treatment success (<i>p</i> > .9).</p><p><strong>Conclusion: </strong>Prism therapy appears effective in improving ocular alignment and visual symptoms across all three types of ocular motor palsy. Its benefits extend to reducing diplopia and abnormal head posture, and selectively improving ptosis and torsional symptoms in certain cases. These findings support the broader application of prism therapy as a valuable non-surgical management strategy.</p>","PeriodicalId":51700,"journal":{"name":"Strabismus","volume":" ","pages":"263-271"},"PeriodicalIF":0.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145508002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of strabismus surgery on static and dynamic pupillometry.","authors":"Şenol Sabancı, Sibel Yavuz, Esra Kizildag Özbay, Merve Bozkurt Gencer, Mehmet Fatih Küçük, Muhammet Kazım Erol","doi":"10.1080/09273972.2026.2630733","DOIUrl":"10.1080/09273972.2026.2630733","url":null,"abstract":"<p><strong>Purpose: </strong>Many factors influence pupil diameter, including ocular surgery. The purpose of this study was to investigate the effects of strabismus surgery performed through a limbal incision on static and dynamic pupillometry.</p><p><strong>Method: </strong>Static and dynamic pupillometry measurements were made and compared in 32 eyes of 32 patients who were scheduled to undergo horizontal muscle recession and resection through a limbal incision in one eye preoperatively and postoperatively on 10 day and at months 1 and 3.</p><p><strong>Results: </strong>All postoperative scotopic pupil diameter measurements of the cases were found to be significantly higher than the preoperative scotopic pupil diameter (<i>p</i> = .0027). In the dynamic pupillometry analysis, a significant difference was found between preoperative and postoperative day 10 and month 1 pupil diameter values of the cases for the measurements taken at seconds 1 and 2 and (p¹=0.0033, p²=0.0039, and p⁵=0.0238). No significant difference was found between preoperative and postoperative values for dynamic pupillometry pupil dilation velocities at any evaluation point.</p><p><strong>Conclusion: </strong>We believe that after strabismus surgery, the balance between the parasympathetic and sympathetic nervous systems, which determine the pupil diameter, is disrupted to the detriment of the parasympathetic nervous system.</p>","PeriodicalId":51700,"journal":{"name":"Strabismus","volume":" ","pages":"327-333"},"PeriodicalIF":0.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146221989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Pediatric Brown syndrome in the setting of hypercholesterolemia: case report of a possible new association\".","authors":"Anam Ansari, Saumya Kashyap, Aarushi Saini, Aditi Yadav, Subhash Dadeya","doi":"10.1080/09273972.2026.2637563","DOIUrl":"10.1080/09273972.2026.2637563","url":null,"abstract":"<p><p><i>Introduction and clinical importance</i>: Brown Syndrome is a form of vertical strabismus characterized by limitation in elevation of the eye in the adducted position, main pathology attributed to superior oblique tendon-trochlear complex, which can either be congenital or acquired, secondary to trauma, inflammation, or iatrogenic in nature. <i>Case Presentation</i>: A 7-year-old male presented for a routine checkup to the out-patient department and upon clinical examination showed a limitation of extraocular movement of the right eye in adduction in elevation, with no deviation in primary gaze. On slit lamp examination, arcus juvenilis was observed in both the eyes with no other observable ocular abnormalities. A blood workup revealed highly deranged lipid profile levels and a diagnosis of familial hypercholesterolemia was made after pediatric medicine evaluation. <i>Clinical discussion</i>: Brown syndrome is an uncommon eye disorder, typically characterized by a restriction of movement in the direction of movement of superior oblique tenson, leading to inability in moving the affected eye superiorly, particularly in the adducted position. Acquired Brown syndrome can be due to a number of systemic diseases, such as dysthyroidism, rheumatoid arthritis, systemic lupus erythematosus, and many more. However, an association between dyslipidaemia or hypercholesterolemia has not been mentioned in literature. <i>Conclusions</i>: Brown syndrome and familial hypercholesterolemia encountered in our patient could either be a coincidental finding or could be an association which has yet to be explored. Lack of any preexisting literature highlights the need to explore more on this frontier.</p>","PeriodicalId":51700,"journal":{"name":"Strabismus","volume":" ","pages":"445-449"},"PeriodicalIF":0.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147345855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abbreviated prism adaptation protocol integrated with alternate prism cover testing for preoperative measurement in acute acquired comitant esotropia.","authors":"Daixi Chen, Tianyu Cheng, Linlin Du, Jun Chen, Xun Xu, Xiangui He, Jun Qiang","doi":"10.1080/09273972.2026.2624379","DOIUrl":"10.1080/09273972.2026.2624379","url":null,"abstract":"<p><strong>Purpose: </strong>This study evaluated an abbreviated prism adaptation protocol integrated with alternate prism cover testing (APCT) for more precise measurement of  maximum deviation anglesin acute acquired comitant esotropia (AACE).</p><p><strong>Methods: </strong>This retrospective study analyzed 89 AACE patients who underwent unilateral medialrectus recession combined with lateral rectus resection between September 2020 and March 2023. Each patient underwent both traditional APCT and abbreviated prism adaptation protocol (APCT-abbreviated PAT) measurement preoperatively.Surgical planning was based on APCT-abbreviated PAT results, while traditional APCT measurements were recorded for comparison of the two measurement protocols. Surgical outcomes were evaluated at 3 months postoperatively, with success defined as residual deviation ≤5 prism diopters (PD) and absence of symptomatic diplopia in daily activities.</p><p><strong>Results: </strong>The study population (mean age: 34.1 ± 14.9 years; mean spherical equivalent [SE]: -4.46 ± 2.53 diopters) exhibited significantly greater preoperative deviation measurements with APCT-abbreviated PAT compared to conventional APCT alone. The mean differential was 11.2 PD (95% CI: 7.7-14.7) for distance fixation and 9.6 PD (95% CI: 5.2-14.0) for near fixation (both <i>p</i> < .001). Surgical planning was based on the APCT-abbreviated PAT measurements. At 3-month follow-up, all subjects achieved successful surgical outcomes with alignment within 5 PD and absence of symptomatic diplopia in daily activities. Worth four-dot testing demonstrated significant improvement in binocular sensory function,with 85.4% achieving normal fusion at distance and 100% at near fixation postoperatively (<i>p</i> < .001). No patients exhibited suppression atpostoperative follow-up.</p><p><strong>Conclusions: </strong>An abbreviated prism adaptation protocol integrated with alternate prism cover testing facilitates quantification of maximum deviationangles in AACE. All patients achieved successful surgical outcomes at 3-monthfollow-up, supporting the clinical utility of this approach for accurate preoperative measurement and surgical planning in AACE patients.</p>","PeriodicalId":51700,"journal":{"name":"Strabismus","volume":" ","pages":"316-326"},"PeriodicalIF":0.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146144583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of facial anthropometric features on exotropia perception.","authors":"David Mothy, Mal Mehari, Elizabeth L Turner, Christian D Raimondo, Jeffrey Xi, Ekjot Dhillon, Brooke D Saffren, Kammi B Gunton","doi":"10.1080/09273972.2026.2719731","DOIUrl":"https://doi.org/10.1080/09273972.2026.2719731","url":null,"abstract":"<p><strong>Introduction: </strong>To evaluate whether subtle facial anthropometric variations may influence the perceived noticeability of exotropia.</p><p><strong>Methods: </strong>This was a cross-sectional study of adult participants over the age of 18 years old recruited via social media platforms. Digitally generated facial images were used to create a baseline male face with a constant moderate-angle left exotropia and eight modified images with ±5% changes in palpebral fissure length, intercanthal distance, facial width, and facial height. Participants completed randomized pairwise comparisons, selecting which image demonstrated more noticeable ocular misalignment. Relative noticeability was quantified using Elo rating scores. A Bradley-Terry model was used to estimate odds ratios comparing each modified image with baseline. Subgroup analyses were performed by sex and age. The main outcome measure was perceived noticeability of exotropia based on participant-selected pairwise comparisons.</p><p><strong>Results: </strong>A total of 201 participants completed the survey (mean age 32.5 ± 11.4 years; 59.2% female). Both decreased palpebral fissure length (Elo score: 1 517.27 ± 16.6) and decreased intercanthal distance (Elo score: 1 512.72 ± 14.1) were ranked as having higher perceived noticeability of exotropia, whereas increased palpebral fissure length (Elo score: 1 485.58 ± 16.4) was ranked as having a lower perceived noticeability. In the Bradley-Terry model, decreased palpebral fissure length (OR 5.87, <i>p</i> < .001), decreased intercanthal distance (OR 3.96, <i>p</i> < .001), and increased intercanthal distance (OR 1.43, <i>p</i> < .05) were associated with higher odds of perceived noticeability relative to baseline, while increased palpebral fissure length (OR 0.41, <i>p</i> < .001) was associated with lower odds. Modifications in facial width and facial height were not statistically significant compared to baseline. Perceived noticeability did not differ by participant sex or age group.</p><p><strong>Discussion: </strong>Subtle variation in periocular facial anthropometric features may influence the perceived noticeability of exotropia independent of deviation magnitude. Periocular features, particularly palpebral fissure length and intercanthal distance, appear to play a greater role in perception than broader facial dimensions. These findings suggest that facial context may contribute to the cosmetic appearance of strabismus and may help explain variability in perception among patients with similar measured deviations.</p>","PeriodicalId":51700,"journal":{"name":"Strabismus","volume":" ","pages":"1-8"},"PeriodicalIF":0.7,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}