Intermittent Exotropia and Mental Illness

Background and Purpose Although adverse psychosocial effects are well documented among patients afflicted with strabismus, recent studies have shown that children with intermittent exotropia, unlike the more prevalent forms of esotropia, are at an increased risk for developing frank mental illness by early adulthood. The purpose of the study was to provide a brief overview of current findings regarding the nonophthalmic aspects of this common condition. Patients and Method Recent reports will be reviewed regarding psychosocial effects and mental illness among children with intermittent exotropia. Results Children with intermittent exotropia have been shown to have a nearly three-fold increased incidence of developing mental illness, compared to controls, by the third decade of life. Moreover, males had significantly more mental health morbidity than females. Although quality of life measures have demonstrated improved psychosocial outcomes among children who underwent successful strabismus surgery, frank mental illness appears to be less amenable to such intervention. Conclusion In addition to the adverse psychosocial affects observed in children with strabismus, intermittent exotropia, especially among boys, appears to confer a specific risk for developing frank mental illness. Clinicians managing such patients should consider the entire physical and psychological aspects of this condition and develop strategies for minimizing adverse psychosocial outcomes.