Bjeloš Mirjana, Ćurić Ana, Bušić Mladen, Rončević Katja, Elabjer Adrian
University Eye Department, Reference Center of the Ministry of Health of the Republic of Croatia for Pediatric Ophthalmology and Strabismus, Reference Center of the Ministry of Health of the Republic of Croatia for Inherited Retinal Dystrophies, Reference Center of the Ministry of Health of the Republic of Croatia for Standardized Echography in Ophthalmology, University Hospital "Sveti Duh", Sveti Duh 64, 10000 Zagreb, Croatia.
Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia.
Children (Basel). 2025 Jul 9;12(7):904. doi: 10.3390/children12070904.
A direct link between sensory processing disorder (SPD) and strabismus has not been systematically investigated, though prior studies suggest sensory modulation may influence visual behaviors. Traditional approaches view strabismus through a binary lens-either normal or pathological motor deviation. This report presents a proof-of-concept case suggesting strabismus may represent a neurobehavioral manifestation of sensory processing imbalance, rooted within the broader framework of SPD. We report a pediatric case marked by episodic monocular eye closure triggered by environmental stimuli, without identifiable ophthalmologic or neurologic pathology. The child's symptoms were most consistent with sensory over-responsivity (SOR), a subtype of SPD, manifesting as stimulus-bound monocular eye closure and secondary self-regulatory behaviors. We propose the suggesting that exotropia and esotropia represent opposing outcomes along a continuum of sensory connectivity: exotropia arising from neural underwiring (hyporesponsivity and fusion instability), and esotropia from overwiring (hyperresponsivity and excessive fusion drive). Our case, marked by sensory hyperresponsivity, showed frequent monocular eye closure that briefly disrupted but did not impair fusion. This suggests an "overwired" binocular system maintaining single vision despite sensory triggers. In early-onset esotropia, such overconnectivity may become maladaptive, leading to sustained convergence. Conversely, autism spectrum disorder, typically associated with hypoconnectivity, may predispose to exotropia through reduced fusion maintenance. These findings highlight the need for interdisciplinary evaluation. We advocate for structured sensory profiling in children presenting with strabismus and, conversely, for ophthalmologic assessment in those diagnosed with SPD. While our findings remain preliminary, they support a bidirectional screening approach and suggest that sensory modulation may play a previously under-recognized role in the spectrum of pediatric strabismus presentations.
尽管先前的研究表明感觉调制可能会影响视觉行为，但感觉处理障碍（SPD）与斜视之间的直接联系尚未得到系统研究。传统方法通过二元视角看待斜视——即正常或病理性运动偏差。本报告展示了一个概念验证案例，表明斜视可能代表感觉处理失衡的一种神经行为表现，其根源在于更广泛的SPD框架内。我们报告了一例儿科病例，其特征为环境刺激引发发作性单眼闭眼，且无明确的眼科或神经病理学异常。该患儿的症状与SPD的一种亚型——感觉过度反应（SOR）最为相符，表现为受刺激约束的单眼闭眼及继发的自我调节行为。我们提出，外斜视和内斜视代表了感觉连接连续体上的相反结果：外斜视源于神经布线不足（反应低下和融合不稳定），而内斜视源于布线过度（反应过度和融合驱动力过大）。我们的病例以感觉反应过度为特征，表现为频繁的单眼闭眼，虽短暂干扰但未损害融合。这表明一个“布线过度”的双眼系统尽管存在感觉触发因素仍维持单眼视觉。在早发性内斜视中，这种过度连接可能会变得适应不良，导致持续的集合。相反，通常与连接不足相关的自闭症谱系障碍可能会因融合维持能力降低而导致外斜视倾向。这些发现凸显了跨学科评估的必要性。我们主张对斜视患儿进行结构化感觉分析，反之，对被诊断为SPD的患儿进行眼科评估。虽然我们的发现仍属初步，但它们支持双向筛查方法，并表明感觉调制可能在儿科斜视表现谱中发挥了先前未被充分认识的作用。
