Epidemiology and Clinical Features of Childhood Strabismus in Tunisia

Aims: To analyze the epidemiological and clinical characteristics of childhood horizontal strabismus in a tertiary care center in Tunisia, highlighting its subtypes, associated risk factors, refractive errors, and sensory-motor implications, with the goal of guiding preventive and therapeutic strategies. Study Design: A retrospective, descriptive observational study. Place and Duration of Study: Department of Ophthalmology, tertiary care hospital in Tunisia, conducted from January 2019 to December 2023. Methodology: Fifty-two medical records of pediatric patients undergoing surgery for horizontal strabismus were reviewed. Inclusion criteria confirmed diagnosis of horizontal strabismus with complete ophthalmologic and orthoptic documentation. Patients with paralytic or secondary strabismus were excluded. Data collected included demographic details, family and personal history, strabismus characteristics, ocular motility, vertical syndromes, refractive errors, visual acuity, amblyopia status, binocular vision, and associated signs. Statistical analysis used descriptive measures with IBM® SPSS v21. Results: The cohort showed a near-equal sex distribution. Esotropia was the most common type, with infantile esotropia being the most frequent subtype. A significant proportion of patients had a family history of strabismus and consanguinity. Hyperopia was the predominant refractive error, frequently associated with astigmatism. Amblyopia was highly prevalent, particularly in early-onset cases. Abnormal retinal correspondence and inferior oblique overaction were common findings. A considerable delay in consultation was observed, leading to advanced disease presentation. Conclusion: Early strabismus predominates in this population and is frequently associated with amblyopia, significant refractive errors, and abnormal binocular vision. Critically, a substantial mean consultation delay of 3.8 years was identified as a major barrier to timely care, directly contributing to the high prevalence of advanced sensory and motor complications. This underscores the urgent need for systematic early screening in primary care and school settings to enable earlier detection and intervention. Tailored surgical and optical management remains essential to preserve visual function. Future multicenter prospective studies are needed to assess long-term visual and psychosocial outcomes and to explore genetic, neurodevelopmental, and environmental risk factors to refine prevention and treatment strategies.