Reconceptualizing Pediatric Strabismus as a Condition Rooted in Sensory Processing Disorder: A Novel Case-Based Hypothesis
<b>Background/Objectives:</b> 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—eith...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2025-07-01
|
| Series: | Children |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2227-9067/12/7/904 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850076945701666816 |
|---|---|
| author | Mirjana Bjeloš Ana Ćurić Mladen Bušić Katja Rončević Adrian Elabjer |
| author_facet | Mirjana Bjeloš Ana Ćurić Mladen Bušić Katja Rončević Adrian Elabjer |
| author_sort | Mirjana Bjeloš |
| collection | DOAJ |
| description | <b>Background/Objectives:</b> 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. <b>Methods:</b> 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. <b>Results:</b> We propose the <i>Fusion Dysregulation Hypothesis,</i> 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. <b>Conclusions:</b> 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. |
| format | Article |
| id | doaj-art-8a77994e5a6e4e3fbc56dd60a1bf0f33 |
| institution | DOAJ |
| issn | 2227-9067 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Children |
| spelling | doaj-art-8a77994e5a6e4e3fbc56dd60a1bf0f332025-08-20T02:45:54ZengMDPI AGChildren2227-90672025-07-0112790410.3390/children12070904Reconceptualizing Pediatric Strabismus as a Condition Rooted in Sensory Processing Disorder: A Novel Case-Based HypothesisMirjana Bjeloš0Ana Ćurić1Mladen Bušić2Katja Rončević3Adrian Elabjer4University 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, CroatiaUniversity 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, CroatiaUniversity 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, CroatiaSchool of Medicine, Catholic University of Croatia, 10000 Zagreb, CroatiaSchool of Medicine, University of Zagreb, 10000 Zagreb, Croatia<b>Background/Objectives:</b> 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. <b>Methods:</b> 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. <b>Results:</b> We propose the <i>Fusion Dysregulation Hypothesis,</i> 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. <b>Conclusions:</b> 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.https://www.mdpi.com/2227-9067/12/7/904strabismussensation disordersblinkingticshyperactivity disordersearly diagnosis |
| spellingShingle | Mirjana Bjeloš Ana Ćurić Mladen Bušić Katja Rončević Adrian Elabjer Reconceptualizing Pediatric Strabismus as a Condition Rooted in Sensory Processing Disorder: A Novel Case-Based Hypothesis Children strabismus sensation disorders blinking tics hyperactivity disorders early diagnosis |
| title | Reconceptualizing Pediatric Strabismus as a Condition Rooted in Sensory Processing Disorder: A Novel Case-Based Hypothesis |
| title_full | Reconceptualizing Pediatric Strabismus as a Condition Rooted in Sensory Processing Disorder: A Novel Case-Based Hypothesis |
| title_fullStr | Reconceptualizing Pediatric Strabismus as a Condition Rooted in Sensory Processing Disorder: A Novel Case-Based Hypothesis |
| title_full_unstemmed | Reconceptualizing Pediatric Strabismus as a Condition Rooted in Sensory Processing Disorder: A Novel Case-Based Hypothesis |
| title_short | Reconceptualizing Pediatric Strabismus as a Condition Rooted in Sensory Processing Disorder: A Novel Case-Based Hypothesis |
| title_sort | reconceptualizing pediatric strabismus as a condition rooted in sensory processing disorder a novel case based hypothesis |
| topic | strabismus sensation disorders blinking tics hyperactivity disorders early diagnosis |
| url | https://www.mdpi.com/2227-9067/12/7/904 |
| work_keys_str_mv | AT mirjanabjelos reconceptualizingpediatricstrabismusasaconditionrootedinsensoryprocessingdisorderanovelcasebasedhypothesis AT anacuric reconceptualizingpediatricstrabismusasaconditionrootedinsensoryprocessingdisorderanovelcasebasedhypothesis AT mladenbusic reconceptualizingpediatricstrabismusasaconditionrootedinsensoryprocessingdisorderanovelcasebasedhypothesis AT katjaroncevic reconceptualizingpediatricstrabismusasaconditionrootedinsensoryprocessingdisorderanovelcasebasedhypothesis AT adrianelabjer reconceptualizingpediatricstrabismusasaconditionrootedinsensoryprocessingdisorderanovelcasebasedhypothesis |