Surgical Management of Pediatric Horizontal Strabismus: Techniques, Outcomes and Indications in a Retrospective Cohort

Abstract

Aims: This study aimed to evaluate the efficacy and outcomes motor, sensory, cosmetic, and psychosocial of surgical management for horizontal childhood strabismus, and to analyze the application of different surgical techniques. Study Design: A retrospective, single-surgeon, observational cohort study. Place and Duration of Study: Ophthalmology Department, Regional Hospital of Kasserine, Tunisia; surgeries performed between 2019 and 2021, with follow-up ranging from 5 months to 2 years (mean: 1.2 years). Methodology: Fifty-two patients with horizontal strabismus were included. Exclusion criteria were paralytic, anatomical, microtropic, or pure accommodative strabismus, and insufficient follow-up. Surgical techniques included recession, resection, posterior myopexy (Fadenoperation), and botulinum toxin injections. Motor success was defined as residual deviation ≤10 prism diopters (PD) horizontally and ≤4 PD vertically. Sensory success was defined as stable fusion and stereopsis <200 arcseconds. Results: The mean age at surgery was 12.6 ± 8 years. Long-term motor success was achieved in 69.2% of patients (65.7% in esotropia, 70.6% in exotropia). Sensory improvement was more limited: stereopsis improved in 16 patients (30.4%), while fusion was achieved in 13 patients (25%). Psychosocial outcomes were favorable, with most children reporting improved self-esteem, social interaction, and school performance. Only one patient required reoperation; no major complications occurred. Conclusion: Surgical management of pediatric horizontal strabismus achieves satisfactory and stable motor alignment, modest but meaningful sensory recovery, and significant cosmetic and psychosocial benefits. These findings highlight the importance of early diagnosis and integrated management including amblyopia therapy, optical correction, and timely surgery to optimize long-term outcomes.