Outcomes of adult new-onset strabismus presenting acutely
Reviewed by Fiona Rowe

This study evaluated causes, neuroimaging rates and results, and clinical courses of adults presenting to an ophthalmology emergency department with diagnosis of new-onset strabismus. This was a retrospective study of 557 adults (54.8% male) with mean age of 57.3 ±16.7 years (range 18-92). Of these, 40.6% were aged 50-64 years, and 35.4% were ≥65 years if age. Symptoms included diplopia (72.4%), ptosis (6.3%) and eye pain (3.4%). Diagnoses included cranial nerve palsy (66.8%: sixth>third>fourth>mixed), restrictive strabismus (5.4%), stroke (4.7%) and thyroid eye disease (3.1%). Causes included microvascular (48.1%), masses (5%), trauma (4.8%), and idiopathic (12.7%). Neuroimaging findings confirmed lower rates of abnormal findings in microvascular cranial nerve palsies and supports the recommendation for a higher threshold for neuroimaging in acute setting of cranial nerve palsy with suspected microvascular cause.

Trends in etiologies, demographics and neuroimaging in new-onset adult strabismus at an adult emergency department.
Patel AJ, Cavuoto KM.
JOURNAL OF PEDIATRIC OPHTHALMOLOGY AND STRABISMUS
2022;59(4):269-73.