## Epidemiology of Strabismus in Children **Key Point:** Esotropia is the most common type of strabismus in children, accounting for approximately 50–60% of all cases of strabismus in the pediatric population. ### Classification and Prevalence | Type | Prevalence | Age of Onset | Key Features | |------|-----------|--------------|---------------| | **Esotropia** | 50–60% | Infantile (< 6 months) or Accommodative (2–3 years) | Inward deviation; most common | | Exotropia | 25–35% | Variable; often intermittent initially | Outward deviation; more common in older children | | Hypertropia | 5–10% | Variable | Vertical deviation; less common | | Cyclotropia | Rare | Variable | Torsional deviation; very rare in isolation | ### Subtypes of Esotropia in Children 1. **Infantile (Congenital) Esotropia** - Onset: Before 6 months of age - Deviation: Large (40–60 prism diopters) - Associated with: Nystagmus, dissociated vertical deviation (DVD) - Management: Early surgical correction (around 18–24 months) 2. **Accommodative Esotropia** - Onset: 2–3 years of age - Mechanism: Hyperopia → excessive accommodation → convergence - Management: Glasses (cycloplegic refraction), sometimes miotics 3. **Non-Accommodative Esotropia** - Onset: Variable - No significant hyperopia - Requires surgical management **High-Yield:** Esotropia > Exotropia in young children; exotropia becomes relatively more common in older children and adolescents. **Mnemonic:** **ENDO-EARLY** — Esotropia is the most common, often appears early in life (infantile or early childhood). **Clinical Pearl:** Screening for esotropia at birth and during early childhood visits is crucial for preventing amblyopia and ensuring normal binocular vision development. [cite:Parson's Diseases of the Eye 22e Ch 12] 
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