PURPOSE To report the long-term outcomes of a population-based cohort of children diagnosed with congenital esotropia during a 30-year period. METHODS The medical records of all patients diagnosed with congenital esotropia as residents of Olmsted County, MN, from January 1, 1965, through December 31, 1994, were retrospectively reviewed. RESULTS A total of 130 children were diagnosed during the 30-year period at a median age of 7.4 months with a mean deviation of 30Δ. During a median follow-up of 11.9 years, 126 patients underwent a mean of 1.8 strabismus surgeries. The risk for undergoing a second surgery was significantly greater in patients with a larger presenting angle (p = 0.017) and a younger age at first surgery (p = 0.006). The Kaplan-Meier rate of having a second surgery was 51% at 10 years and 66% at 20 years. For those with 6 weeks or more of follow-up from the final surgery, last examined at a mean age of 15.1 years, 42 of 94 (45%) were within 8Δ of orthotropia and 30 of 98 had some level of stereopsis (≤3000 arcsec). CONCLUSIONS In this population-based study of children with congenital esotropia, a second surgery was necessary in half the patients after 10 years and was more likely in those patients with a larger presenting angle and a younger age at first surgery. Approximately half of the patients were within 8Δ of orthotropia and one-third had measurable stereopsis after a mean of 10.9 years of follow-up.

Objective The purpose of this study is to investigate whether children with congenital esotropia are more likely than controls to develop mental illness by early adulthood. Design Retrospective, population-based cohort. Participants Children (<19 years) diagnosed with congenital esotropia while residing in Olmsted County, Minnesota, from January 1, 1965, through December 31, 1994, and their one-to-one non-strabismic birth- and gender-matched controls. Methods The medical records of patients with esotropia and their controls were retrospectively reviewed for the subsequent development of psychiatric disease. Main Outcome Measures The development of mental illness and associated co-morbidities among patients with congenital esotropia and their controls. Results A mental health disorder was diagnosed in 42 (33%) of the 127 patients with congenital esotropia followed to a mean age of 20.4 years compared to 16% of controls (p=0.002). Congenital esotropia increased the odds of developing a psychiatric illness 2.6 times (Confidence interval: 1.5- 4.8) compared to controls. The number of mental health diagnoses (p=0.019) and the use of psychotropic medications (p= 0.015) were significantly more common among esotropic patients compared to non-strabismic controls. Conclusions Congenital esotropia, similar to those with intermittent exotropia or convergence insufficiency, increases the odds of devloping mental illness by early adulthood 2.6 times compared to controls. The etiology of this association does not appear to be associated with premature birth.

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Primary episcleral melanoma is a previously unreported complication of ocular melanocytosis, and should be considered in the differential diagnosis in patients with ocular melanocytosis and pigmented nodules on the ocular surface.