Children with strabismus are at a significantly increased risk of developing mental illness by early adulthood, according to a study in the November issue of Pediatrics.

The retrospective study examined the medical records of 407 patients with strabismus and compared them with the records of children matched for age and sex, but with normal eye alignment.

The researchers found that children with exotropia were three times more likely to develop a psychiatric disorder than children with normal eye alignment, yet children with esotropia showed no increase in the incidence of mental illnesses.

Also, patients with intermittent exotropia were significantly more likely to have mental health disorders, mental health-related emergency department visits, mental health-related hospitalizations and thoughts of suicide or homicide.

This can be crucial information for primary-care doctors. Pediatricians and family practice physicians who see children with strabismus should be aware of the increased risk of mental illness, says lead author Brian Mohney, M.D., of the Mayo Clinic, in Rochester, Minn. They can hopefully be alert to the earliest signs of psychiatric problems in patients with exotropia, so they can consider having them seen by a psychologist or psychiatrist.

Mohney BG, McKenzie JA, Capo JA, et al. Mental illness in young adults who had strabismus as children. Pediatrics 2008 Nov;122(5):1033-8.