Pseudoesotropia in Chinese Children: A Triphasic Development of the Interepicanthal Folds Distance-to-Interpupillary Distance Ratio and Its Changing Perception

PURPOSE: To delineate the development of the interepicanthal fold distance (IEFD) to interpupillary distance (IPD) in Chinese children, and to quantify how their ratio (EFDPD ratio) affects parent’s judgment on whether a child’s two eyes appear misaligned. METHODS: The values of IPD and IEFD were measured in 750 children, aged between 3 and 17 years. The developmental trend of EFDPD ratio was established. Two hundred parents were shown a series of pictures of children with varying EFDPD ratios and asked to judge whether the child in each picture demonstrated misaligned eyes. Based on the parent’s responses, psychometric functional associations with EFDPD ratios were established. RESULTS: The EFDPD ratios were significantly higher (0.63 ± 0.027) and showed little change among children from 3 to 6 years of age (p = 0.704). During the age of seven to 12 years, however, the EFDPD ratio significantly decreased (p < 0.001) before stabilizing at 0.59 ± 0.023 by the ages of 13 to 17 years (p = 0.376). Children with EFDPD ratios > 0.65 were more likely to be perceived as strabismic by the parents, while children with an EFDPD ratio < 0.55 were rarely perceived as so. As many as 30% of the children aged between 3 and 6 years demonstrated EFDPD ratios > 0.65, and this number reduced to 5% by the age of 12 years. CONCLUSIONS: The development of the EFDPD ratio in Chinese children shows a triphasic pattern, with a large value before the age of 6 years, a quick drop between 7 and 12 years, and little change after 13 years of age. As the EFDPD ratio declines, fewer children appear as strabismic. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266