Paper 9

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Incidence and Profile of Strabismus in an Acute Stroke Population

Fiona J. Rowe; Lauren R. Hepworth; Kerry Hanna; Claire Howard
University of Liverpool
Liverpool UK

Introduction:  Strabismus in stroke survivors is reported in about 30% [1]. There is limited information about its specific profile when due to stroke. This study reports the incidence of stroke-related strabismus, characteristics and recovery.


Methods:  Prospective epidemiology study of all stroke survivors admitted to three UK acute stroke units over a 15-month period. Full documentation of stroke demographics and orthoptic assessments, including visual acuity, visual fields, visual perception, ocular alignment and motility.


Results:  1500 stroke survivors were recruited from 01/07/2014 to 30/06/2015 with follow-up through to 31/12/2016. Mean age was 73.2 years (SD 14). 189 had documented strabismus; 70 pre-existent and 119 new onset. Of new cases, 110 were recruited during the first year; annual incidence of stroke-related strabismus of 8.5%. 172 were ischaemic strokes; 17 haemorrhagic (88 right-sided, 80 left-sided and 21 bilateral). Exotropia occurred most commonly: 61.9% at near and 49.7% at distance fixation. Strabismus-related symptoms were reported by 54.5%. Ocular motility deficits were associated in 77.7% with associated visual field loss in 30.7%, visual perceptual deficit in 31.7% and impaired central vision in 75%. Management for 92.6% of patients included prisms, occlusion, compensatory advice. Recovery, where documented, ranged from within 1 week to 11 months.


Discussion:  Acute onset strabismus is an important referral to ophthalmic services. This study reports an incidence of stroke-related strabismus of 8.5%. Over half were symptomatic and most required management.


Conclusion:  Providing appropriate care to this at-risk population is important to their general rehabilitation to maximise functional ability.


References:  1. Hepworth LR, Rowe FJ, Walker MF, Rockliffe J, Noonan C, Howard C, Currie J. Post-stroke Visual Impairment: A Systematic Literature Review of Types and Recovery of Visual Conditions. Ophthalmology Research: An International Journal. 2015; 5(1). ISSN: 2321-7227

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